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Reactions to the coronavirus outbreak

Yale Medicine Magazine, 2019 - Autumn


Yale experts shared the depth of their knowledge on the treatment of viral disease to communicate the nuance and urgency of the coronavirus disease 2019 (COVID-19) outbreak. Across the media, scholars from Yale School of Medicine and Yale School of Public Health offered warnings, analysis, and potential life-saving interventions, underlining the urgency of coordinating a comprehensive response to the spread of COVID-19.

“We are in a crisis,” Howard Forman, MD, MBA, professor of radiology and biomedical imaging and professor of public health, told Business Insider. Forman warned that inadequate testing for coronavirus in the United States means there are likely far more people with the virus than are currently thought.

“We are grossly under-testing at this point,” Forman said, following up on his comments. “Until we start testing adequately, we can neither reassure the public nor make efforts at containment/mitigation and compassionately care for those who are infected or might be exposed.”

Containment may not even be possible at this point, said Albert Ko, MD, chair and professor of epidemiology (microbial diseases) and of medicine (infectious diseases). “We have to figure out how to mitigate the spread of the virus,” he told NBC Connecticut.

Ko is part of a WHO Blueprint working group focused on advising how new vaccines and therapeutics for coronavirus should be evaluated. Yet according to Ko, the approval and distribution of a vaccine could take up to a year. “The step that takes a long time is actually showing that [the potential vaccines] are safe and effective.”

Yet there is more immediate action that can be taken. “What we really need to do is prevent people from getting the flu,” Ko said. “That would relieve the burden on our hospital systems, so that when new coronavirus comes, we can actually provide better care.”

Ko emphasized this point in The Washington Post. “The best thing people can do is get immunized for influenza to free up services for people who come in with coronavirus,” he said. The presentation of symptoms for influenza and coronavirus can initially be similar, and difficult to distinguish. “When we’re testing people [for coronavirus], it reduces the noise about who has it.”

Despite the caution against coronavirus across the entire population, some groups of people appear to be more susceptible to the virus than others. Adults are at greater risk than children, according to Akiko Iwasaki, PhD, Waldemar Von Zedtwitz Professor of Immunobiology and Molecular, Cellular and Developmental Biology, professor of molecular, cellular and developmental biology, and Investigator, Howard Hughes Medical Institute, told The Philadelphia Inquirer that the immune system of adults can overreact, and produce harmful levels of inflammatory levels in response to the virus. Older people also have chronic, low-levels of inflammation in their bodies, called “inflammaging.”

“You have this perfect storm of not having the right antiviral defenses and having elevated inflammaging,” Iwasaki said.

Yale experts offered not only warnings about the clinical approach to coronavirus, but also raised alarms about the approach of the federal government to combating the outbreak. Some are critical of the appointment by President Donald Trump of Vice President Mike Pence as director of the White House response to coronavirus.

Gregg Gonsalves, PhD ’17, assistant professor of epidemiology (microbial diseases), and Forrest Crawford, PhD, associate professor of biostatistics, both of the Yale School of Public Health, described on how Pence, as governor of Indiana, had failed to act on warnings from public health experts of an HIV outbreak. This led to more than 200 cases of HIV in one county, delaying the overturn of a state ban on needle exchange programs.

In a study published in The Lancet HIV in 2018, Gonsalves and Crawford used a mathematical model to determine what the potential impact of an earlier use of a needle exchange program would have been on the HIV outbreak in the county. “We estimated that up to 127 HIV infections could have been averted if Pence had implemented public health measures like HIV testing and needle exchange proactively in 2013, when he had been urged to do so by experts in his state,” they said in Politico. “If Pence could not handle a preventable outbreak of HIV in his home state, he may not be prepared to address the far larger and more complex challenge presented by the novel coronavirus SARS-CoV-2 as it spreads across the United States.”

On campus, Saad B. Omer, MPH, PhD, professor of medicine (infectious diseases), Susan Dwight Bliss Professor of Epidemiology of Microbial Diseases, Yale School of Public Health, adjunct professor, Yale School of Nursing, and director of the Yale Institute for Global Health (YIGH), moderated a panel of YSM experts in mid-February that dealt with coronavirus. Omer is engaged in multiple research projects related to COVID-19. For example, he has completed a national study on risk perceptions regarding COIV-19 and, in collaboration with colleagues at Emory University, he is working on a mathematical model of interventions to mitigate the impact of COVID-19 outbreaks in confined settings such as cruise ships and residential colleges. He also published widely shared and sadly prescient op-eds in The New York Times and TheWashington Post on America’s level of preparedness to meet outbreaks. YIGH has been a global leader in tracking and messaging about the spread of COVID-19.