A panel of experts brought together by the Emory Global Health Institute met to discuss COVID-19 and its potential impacts on hospitals, airports and other institutions. After the discussion, WebMD senior medical director Hansa Bhargava, MD, asked the panel questions from the WebMD audience about the new virus and what its growing spread could mean in the U.S.
Panelists included: Henry Wu, MD, assistant professor, division of infectious diseases, Emory School of Medicine; Marybeth Sexton, MD, epidemiologist, The Emory Clinic; Paul Meyer, assistant general manager, operations and transportation, Hartsfield-Jackson Atlanta International Airport; Jim Lavery, Conrad N. Hilton Chair in global health ethics, Emory Center for Ethics.
Questions have been edited for clarity and length.
Bhargava: What makes coronavirus so different from the flu? We have over 29 million diagnosed with the flu, we have over 200,000 hospitalized with the flu, and we have thousands of people who have died, some of whom are children. Why are we so stressed out about coronavirus when flu is rampant?
Wu: The illness looks like the flu at first … and I’ve raised the possibility that maybe the mortality is on the very low end and maybe in line with flu, and the reality is that we don’t know yet. It’s still too early. But let me just say one thing that’s important to keep in mind. Let’s say it is like the flu if there is a pandemic and it is spread around the world: Do we need another flu? Do we need 40,000 more deaths a year? If you’ve been to our hospitals during flu epidemic or ERs, it’s tough. We certainly care about the health of everyone in our hospitals. The reality is that even if it is like the flu and it were to become common, that would be a serious challenge.
Bhargava: Do we have enough time to prepare for this in a similar way that we would for SARS, where the mortality rate was 10% or Ebola where the mortality rate was almost 90%?
Sexton: I think what we’re trying to do is see if this has passed the point where it can be contained, and it’s definitively going to be a pandemic, or whether we can still get on top of it. I think that remains to be seen, but I think either way, the strategies you put into place are the same. And they are this idea that you want to, as the CDC has stressed, identify the patients who may have this, isolate them so they don’t infect anyone else, including their healthcare workers. One of the most important things … is that your healthcare workforce isn’t decimated by the illness, and that you inform the relevant people, that you let the people in the hospital who will take care of these people know what’s going on, and that you let public health authorities know as well, because there’s a huge amount of community coordination that’s necessary to try to get a handle on something like this… This is not a situation … where we want to see panic. We want to see appropriate levels of concern that lead to action, and I think that with putting those kinds of measures in place, we should have some success at containing this.
Bhargava: The city of San Francisco called for a state of emergency around this. In terms of the numbers of diagnosed infections in the United States, is that appropriate or ethical?
Lavery: One of the fundamental challenges that we face is that it’s an extraordinarily difficult situation to collect evidence in. How do we know that we have not been successful in containing, and there’s a kind of mysteriousness about whether we will ever be able in real time to get a sense about what constitutes the least restrictive means. So when you look at urbanization, like what’s happening in China in particular where you have these huge quarantine type activities around cities of 13, 14, 15 million people, it’s hard to understand how that could possibly be the least restrictive approach. But again, who’s going to object? What are the processes for objecting? So I think what happens is often we just get left to decide, countries, cities make the decisions, and then it’s after the fact that we kind of have to do the unpacking and … we’re not as interested in collecting that kind of evidence after the fact. We’re left in this kind of constant state of not having to have enough evidentiary basis for making the kind of decisions that we need to insure that civil liberties aren’t violated arbitrarily.
Bhargava: Do we have enough tests in the United States to handle a mass outbreak?
Wu: Our testing capacity is limited …so I think it is a challenge. I mean no doubt, this is a disease that nobody even knew existed four months ago, so I think if anything we should be thankful that things can move this fast. We’re not testing necessarily everybody who might have the disease, that’s the reality, I think we have to admit that.
Sexton: A lot of the state health departments and even individual hospitals are working on bringing up testing to rapidly scale that capacity, but I think it’s important to remember too that we don't test everybody for flu. When we get to a certain prevalence in the community, we assume that somebody with the right symptom constellation has it, and we save the laboratory work and the money that’s billed to the patient, all those things, so I think that’s what’s happened in China. The only thing that really impacts is the mortality rate you’re seeing, because they’re not testing people who are barely ill enough to seek medical care… and it’s looking like it’s more fatal than it really is. But the people who are really benefiting from treatment because they’re hospitalized or critically ill are getting tested, so I think that’s the other important thing we'll have to consider about how we scale that capacity.
Bhargava: Data-sharing obviously has its benefits and having open-source platforms, but how do people at the front line actually get real-time information when it’s changing by the minute?
Sexton: One of the things to remember with data-sharing and the availability of some of this information is that it is all out there without a lot of filtering or context or explanation, and that has downsides in addition to the things that are good. If we started telling our employees we fielded three phone calls today about concern for coronavirus, people might get the impression that there are people wandering around in Emory Healthcare who are at risk, when we were actually fielding calls for, ”Hey, I ate at a Chinese restaurant and now I have a cold, should I be worried?” And so it’s that kind of information that has to be put in context for people in a way that makes sense and that is both accurate and reassuring, so you want people to have the real information. If we have a patient we would want people who work in the hospital to know that, but we need to protect patient privacy, and we need to make sure people have the facts and that they get the information that they can act on.
Bhargava: Should we prepare for this like we would prepare for a major storm, like getting batteries and water and food? And should we be wearing masks?
Sexton: There is absolutely no indication in the United States to walk around in a mask right now. Please don’t. What that does is it uses masks that we need in the healthcare system for people who are trained in how to use them and who legitimately need them to protect themselves. For one thing, when you’re walking around outside, you’ve got airflow, you’re not having close, prolonged, face-to-face contact with somebody. You don’t need a mask on. Also there’s never been good data on whether wearing surgical masks really protects people against something like this in the community. All that data’s from healthcare settings, where you’ve got personnel who are trained in how to use them, following other infection control measures like washing their hands and not touching their face, and you have other engineering controls like airflow in the rooms, that protect them. So the people who should be wearing a mask are anybody who actually is ill, who is seeking medical care, should put a mask on in a waiting room in a healthcare setting so they don’t transmit to the healthcare workers or the other patients, but other than that, there’s no indication to wear a mask.
Wu: Preparing for emergencies … that advice is already out there for hurricanes and everything, so there are some things that are never a bad idea, and this is just another reason, so I think that was all the messaging this week from the CDC is that the public should just be aware and prepare, not panic, but just be prepared.