Dr. Amesh Adalja is a Senior Scholar at the Johns Hopkins University Center for Health Security. His work is focused on emerging infectious disease, pandemic preparedness, and biosecurity.
Recommended Reading: COVID19: A Path Forward by Amesh Adalja
Some key takeaways:
- Asynchronous outbreaks around the world – worldwide cases are coming again (South Korea) — the virus is not going anywhere;
- We are going to be dealing with COVID-19 for the next two years until a vaccine is developed;
- South Korea COVID-19 Response was “textbook”: acted quickly and took the right actions’;
- Keep the number of cases so not to overwhelm hospital capacity — in Japan had to reimplement lockdown when cases spiked up again;
- The jury is still out on Sweden: most deaths in nursing homes; still some restrictions on large crowds; Swedes tend to social distance “naturally” (Brook); not appropriate for U.S. hotspots like New York;
- Taiwan “great success story” pounced on this and was very aggressive on testing; injustices against Taiwan; prohibited from WHO (and U.N.) because Taiwan government respects individual rights of citizens;
- Virus mutations: “most mutations have no functional significance”; what matters is how virulent it is (speed of spread);
- Death rates dependent on host (co-factors like obesity and diabetes); can run rampant in nursing homes (must lockdown and be “fortified”) which is high risk;
- Not apocalyptic, but still dangerous: New virus with no protection against it (more deadly and challenging then flu — which we have antivirals for); what makes it deadly is that it can affect everybody; so even if a small amount (0.6);
- Cannot extrapolate one area (high population density like New York City) to another (rural area);
- Politicization has made it hard to get an objective opinion; CDC: “constrained” by the political environment; Dr. Anthony Fauci, director of the National Institute of Allergies and Infectious Diseases (NIAID): “made major breakthroughs”, “pioneer with HIV”, “icon in the field”;
- How durable is immunity? People in South Korea were not reinfected — the test does not test for viable virus, but tests for materials (debris) from virus;
- “Flattening the Curve” is not about saving lives, but spreading cases out over time so as to not overwhelm hospital capacity; as you peel back social distancing the number of cases will go up;
- Hydroxychloroquine is not the answer, but the effectiveness depends on controlled grouped trials; the final solution is a vaccine;
- Island nations (Iceland, New Zeland) are good at infectious diseases as they have a natural barrier;
- Number of cases is less important then hospitalization rates;
- California — lockdown (“blunt instrument”) of the entire state is not necessary at this time; should be done a county level;
- 1968 Hong Kong Flu [influenza A subtype H3N2] compared to COVID-19: This will be worse, but not as bad as 1918 [1918–19 pandemic, which caused between 25 million and 50 million deaths].
- A lot of gray areas: a lot of things we do not know the answer to and are “learning things on the fly”; lots of false alternatives being created between opening up completely and shutdowns;
- What individuals should do: high-risk individuals should avoid COIV-19 at all costs; avoid contact with high-risk individuals so as to not infect them with the virus; different for every person’s risk tolerance; make sure people you visit consent to making contact with you.