Dr. Alfred Sommer '63 answers some questions about the COVID-19 pandemic

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Dr. Alfred Sommers '63

Dr. Alfred Sommer ’63, a global leader in public health, is dean emeritus of the Bloomberg School of Public Health and University Distinguished Service Professor of Epidemiology at Johns Hopkins University. He is perhaps best known for his research showing that children in developing countries with vitamin A deficiencies are at greater risk for blindness and death. As a result, low-cost vitamin A supplements administered to more than 400 million children annually have saved thousands from blindness and death.

On March 25, Dr. Sommer answered some of our questions about the COVID-19 pandemic.

Q: Is there a historical (or current) model that would have predicted the rapid rise we are seeing in New York City and state?

A: The spread of any epidemic is determined by how communicable the disease is, and how many people come in contact with those who are communicable. For example: for some infections, probably like the present Covid-19, the average infected person will transmit the virus to four people. That first person will lead to four infections, but several days later, when each of those four become infectious, we will suddenly have 16 new infections. So one infected person becomes four, becomes 16. This virus is very infectious, and the population of New York is very dense, so people are in close contact increasing the likelihood they will come in contact with someone who is infected (and probably does not yet know it). In areas where the population density is lower, and people more spread out, they are less likely to encounter an infected individual, less likely to get it, and therefore less likely to pass it along. New York City is therefore at extreme risk, why the numbers have grown so rapidly, and why it is now anticipated it will peak in about two to three weeks in the City.

Q: Is this mostly due to density in metro NY? Does anything suggest that this will decelerate or not spread to other major regions?

A: As I noted above, density is definitely an issue, as the denser the population the greater the likelihood a person will be exposed to someone who is infectious (but may not yet realize they are sick). It seems extremely likely that this WILL spread throughout the U.S., but the degree, and the speed with which it does will depend upon travel and local containment precautions. Florida has now proclaimed that anyone coming from NYC “self-quarantine” themselves for 14 days. That SOUNDS sensible, but how exactly are they going to do that? They will have been in a local airport, they need to get to a place (hotel, apartment, home) to stay during which they will inevitably encounter uninfected people, and they will need food and supplies during those 14 days. The greater the degree of precautions they take (only have things brought in, don’t hand cash to the delivery person, etc) they lower the likelihood of their transmitting the disease. But not everyone is going to be equally cautious. Just look at California, where those told to “social distance” themselves as a precaution, instead of going to work congregated at hiking trails! Now California has closed all those trails – and the parking lots you need to use to access them.

Q: NY Gov. Cuomo is focused on getting up to 30,000 ventilators. As of yesterday, the Feds had released 4,000 with many more in storage. Is Cuomo correct in that NY should get all available ventilators and, after the wave, begin sending them to other regions?

A: Every densely populated state wants more ventilators. So, yes, New York definitely needs more ventilators, as do many other cities and states. Our Federal government has been abysmally slow to respond, but as of today the private sector (e.g. Ford motors for one) have begun to work with traditional ventilator producers to scale up much larger production; exactly as we turned out tanks and airplanes from what had been car factories during WWII

Q: Can we restart the economy while protecting the most vulnerable? In other words, can young folks get back to work on a limited basis?

A: This will be safest for those who have been exposed, and survived the virus and therefore are now presumably immune. But since most such people don’t yet know they had the disease, since it is likely many young infected people had minimal if any symptoms, we would need greatly expanded testing for the PAST infection with the virus to know. The test most commonly used now (in far too few instances) only tells us whether you presently are infected with the virus; not whether you were infected in the past but are now immune. Antibody tests that can tell us that are just now becoming available, but the federal government has to provide funding for them to be produced in massive amounts, and set up stations where the testing can be done. To simply have people return to work under usual circumstances is a very dangerous proposition!

Q: Is the President's goal of "packing churches" on Easter realistic, advisable or safe?

A: It presently seems entirely inadvisable. BUT, if the epidemic is over (highly unlikely) one could begin to consider a sound approach for clearing people for a return to work, or church, especially if the workplace and work flow is carefully designed to prevent spread of any remaining infection. But given the present course in the U.S., of continued spread and rapid increases in the number infected (and dead!!) this goal seems hopelessly unrealistic from a public health perspective. “Packing churches” is an abysmal thought, given the continued expansion of the epidemic.

Q: Other thoughts?

A: Two thoughts, worth truly focusing on for the future. 1) We nearly had exactly this same experience with SARS (a similar virus to the present one, but much MORE deadly) in 2003. Fortunately it was also a lot less communicable, and very aggressive quarantining of infections controlled the epidemic which otherwise might well have been truly catastrophic! Lots of planning was done for an effective response in the future, especially the stockpiling of masks, respirators and ventilators. It never happened! We constantly need to learn these lessons all over again! 2) That SARs episode should have resulted in detailed plans for dealing with the next respiratory outbreak (we actually suffer one every year, with “seasonal influenza”, that kills 20,000 – 60,000 Americans annually). Plans that one would simply lift off the shelf and put into operation. Instead, we are once again “making it up as we go along”, reinventing the wheel, and arguing over what one does next. We MUST learn (once again) and this time be well-prepared for the next epidemic – there surely will be one, though we can’t know when for certain.