Efforts to block the global spread of coronavirus appear to have failed, but that does not mean you should panic, says Angela Rasmussen, a virologist who serves on the faculty at the Center for Infection and Immunity at Columbia University’s school of public health.
Rolling Stone reached Rasmussen on Friday evening as news of person-to-person spread of the virus was emerging in California. There are now confirmed cases of coronavirus up and down the West Coast, including patients who did not have an obvious link to foreign travel or infected Americans who were brought home and (shabbily) quarantined. Two coronavirus deaths have been reported in Washington state, where researchers believe the virus may have been circulating, undetected, for weeks.
The leap of coronavirus to the general population means the outbreak has reached a troubling new stage. We asked Rasmussen how Americans should prepare for this new reality — how to ready themselves for life in the time of coronavirus.
Rolling Stone: You’ve argued that “containment is no longer possible” with coronavirus and “it’s now time to shift to mitigation.” How should that change our strategy and tactics in dealing with this outbreak?
Angela Rasmussen: We need to focus on trying to minimize the spread. And that means two things. First of all: making sure that our health care systems are prepared. It also means educating the public about what coronavirus in their community means, how to protect themselves, how to minimize their exposure risks — and also not to panic and overwhelm their health care systems, which is my biggest concern.
How should folks react if they get sick with coronavirus?
I would say that it’s just like if you had the flu. You also don’t need to rush to the hospital and test immediately. I would say, just treat it the way you would another respiratory infection — because it also could be a respiratory infection from something else. It’s still flu season. I would treat this the same way we treat the flu. Don’t freak out.
Keep calm and wash your hands, in other words.
If you have a pre-existing condition, then maybe if you start to experience symptoms, you should see your doctor. But ultimately there’s nothing that we can really do for people until they become severely ill — and then it’s to provide supportive care for them. There’s really no point in freaking out, trying to get into the hospital or overwhelming doctors and health care workers who are going to have their hands full if it does spread widely. There’s a lot of people in this country who are in higher-risk groups. Make sure that you’re thinking of those people before you demand a test or a hospital bed, or just more attention because you’re scared.
So the advice for people who are getting sick with something that feels — “Oh, gosh, I don’t know what this is” — is to sort of take a break, treat it like they would something familiar, and then if it doesn’t get better or they start to become really severely ill, that’s when they should seek care?
And if you really do need care, then you should definitely seek it out. You shouldn’t wait until you’re, like, dying of pneumonia before going to the doctor.
As I’ve followed this, it seems like there was a brief window when this was mostly in China and public-health officials were hoping to contain it and maybe really be vigilant for people moving out of that country — which may have merited all of the high drama and, you know, Outbreak-style suits and draconian restrictions on people’s movements. But I’m confused as to why, now that this seems to be moving into broader circulation, there hasn’t been a messaging move to “Let’s treat this like the flu, be careful, but not have everyone on high alert.”
That’s exactly what I think. You just nailed it. Early on during the epidemic, the unprecedented lockdown that occurred in China potentially could have helped it, but even that was implemented, in my opinion, too late. There were reports that up to 40 percent of the population of Wuhan had actually left prior to travel being restricted, from Wuhan to the rest of China. [Editor’s note: The outbreak coincided with the lunar new year, a period of widespread travel across China.] And our travel restrictions have not been implemented sensibly. I disagree strongly with President Trump’s statement the other day that they, in fact, had worked. There’s no reason to expect that allowing U.S. citizens to come in, as opposed to foreign nationals from China, would not bring the virus in. I mean the virus doesn’t care what passport you’re carrying. It was not an effective way to prevent the spread.
And then there have been a number of other really bad public-health decisions such as the Diamond Princess cruise ship quarantine, which actually amplified spread among the unfortunate people who were stuck on that boat. As well as the confusing repatriation of passengers who were on that ship to the U.S. And these quarantines of people who were evacuated from Wuhan. It’s not clear that they are not infected when they leave quarantine because our testing hasn’t been great.
So this was a lot of action for little payoff?
The efforts at containment largely failed. We’re seeing large clusters of infections, such as in Iran and Italy, where it clearly wasn’t like a bunch of people just became infected overnight. There’s clearly been transition occurring in those places that was not recognized until there were more cases of severe disease, which suggests that that infection is quite widespread. We know that the case fatality rate is quite low — two percent. That seems to have held pretty consistent, as the number of patients has grown. So if you have five patients in Iran that have died, that suggests the other 98 percent are still out there. I don’t think they’ve been recognized. For that reason, we probably have more cases here in the U.S. and elsewhere, that we just have not yet detected.
The two percent figure is very scary to people. How solid is that?
That could certainly change. The China CDC published a report in which they looked at like 45,000 patients and calculated the case fatality rate based on that. Prior to that, the fatality rate was being estimated at around two or three percent. So that is one of the numbers that has remained fairly consistent. My personal opinion, though, is that the case fatality rate could actually be much lower if there’s a bunch of mild cases that we’re not being able to test for.
So we’re talking, perhaps, about the fatality rate for people who become acutely ill, rather than the full number of people who catch the virus. I’ve read that children can often get mild cold symptoms with this, rather than a full-on, flu-like illness. Who is most at risk?
Case fatality rate can change depending on the community that it’s in. So, for example, if you have an outbreak in a nursing home or a retirement community, you’re probably going to have a higher case fatality rate. Because we know that once we get past about age 50 or 60, that case fatality rate starts increasing. It’s 0.1 percent or 0.2 percent for people, I think, through age 49. And then ages 50 through 59 goes up to one percent. Then it goes up to like three percent [for patients in their 60s and 70s], and then it goes, age 80-plus, to like 14 percent case fatality rate. It really depends on the population that the virus is affecting. Also people with pre-existing conditions also have a higher case fatality rate. So that would be like heart disease, diabetes, and asthma.
The Spanish flu of 1918 had the perverse effect of really hammering otherwise healthy people, right?
Yes, that’s correct.
And this virus seems to behave more normally, hitting hardest for people who are either aged or otherwise infirm?
Right. And that’s generally what influenza does. It’s really unclear why the 1918 pandemic had so many deaths of young, able-bodied people. It’s also very difficult to make conclusions about 1918 because we didn’t have antibiotics then.
Given what we’ve been talking about, is it appropriate or useful for places like Japan to be shutting down schools or quarantining an entire island. Or if the virus is on the loose, should public-health officials stop trying to delay the inevitable?
It doesn’t hurt to put restrictions on mass gatherings and things like that. But the reality is we can’t … we can’t just tell the whole world to stay home. We need essential services. So I think that a much better strategy is that we should make sure that people are taking the precautions they need to protect themselves. So if they are suspected to be exposed to somebody who’s infected then self-quarantine, monitoring themselves for symptoms, practicing good hand hygiene, practicing social distancing.
There is a limit, practically, to what we can do in terms of these large-scale lockdowns and canceling of events and closing down schools and so forth. Quarantining entire islands or cities, I don’t think that that has worked. Depending on the situation, it could actually put the people on that island, or community, at greater risk of infection. So it’s really important to make sure that the public-health officials are communicating with the public and advising people on how they can best prepare — and that’s protecting themselves from exposure.
You said you were worried about the public-health system becoming overwhelmed. Is the idea behind some of these containment strategies to slow the rate of infection so that you end up with a slower stream of infected patients? The heavy-handed response is causing so much economic disruption. I’m just trying to understand what the logic is.
Theoretically. That’s what people are giving us as a reason for why the lockdown and travel ban stuff has quote “worked” — because it has theoretically slowed the spread to the rest of the world. But the reality is, we don’t know that, actually. We don’t have an idea how many people here are probably infected. There might be community transmission occurring. So we have really no idea how well this [containment strategy] works.
The good news is that, because in the majority of patients it’s mild, what we should be telling people is that if you are in a low-risk group, you don’t have to rush to the hospital. You should stay home and recover. So that the hospitals are not going to be overburdened with otherwise healthy people when they need to be using their resources for treating the people who are likely to have more severe illness.
I’m just struck by the difference between the flu, which kills how many? 50,000 people in this country? And it’s pretty invisible in terms of the media coverage. Yet we have focused everyone’s attention on the coronavirus problem to the point that they’re going to lose their minds if they’ve got this, versus what they would do with the flu or a bad cold, which is have some chicken soup and chill out.
So what do people need to be doing?
What people need to be doing is start educating themselves on their risks, educating themselves on how they can protect themselves and reduce their risk of exposure, making plans just in case some of these [containment] policies are implemented. Like, it’s always a good time to stock up your emergency preparedness kit, period.
My fear is that now that the CDC’s test is supposedly working again, and it’s being rolled out to all the states, that we’re going to have overnight a whole huge surge in cases, when people inevitably start testing positive more and more frequently. Again, that doesn’t reflect the fact that suddenly all these people spontaneously became infected. It’s that they were infected but we just didn’t know about it. So it’s going to look like a huge jump in the number of cases.
It’s possible that that might not happen. I don’t know for sure. But this virus does seem to be pretty contagious. And, you know, there have been reports of asymptomatic transmission. I’m sure some of that is occurring, but in many cases, people probably have subclinical disease — they have maybe a scratchy throat or a stuffy nose or something, and it’s just not that severe. So they’re not recognizing it for what it is, and they are still being able to spread the virus.
If people suddenly think that there’s a huge surge of cases, they’re going to think that this is like some sort of out-of-control thing. Which, I mean, to a degree it is. But they’re going to overreact and potentially overwhelm the health system is my concern. If people are not prepared, emotionally, to get this news, I think one of the reactions could be panic and also hoarding.
The virus, I’m not as worried about. I’m much more worried about what people’s reaction is going to be — and how our public-health system is going to be handling them.
Say that again. You’re less worried about the virus itself and more worried about panic?
I really have been urging people to stay calm about this. But being calm doesn’t mean being complacent. We should definitely still be concerned. I’m just worried that if people think that this is, like, the end — an existential threat to our species — the way that people react to that news, it’s not necessarily going to be reasonable or helpful for public-health efforts.
This gets back to the original question. Do you think that the failed effort of containment ultimately could be counterproductive in that sense? That it has ratcheted up the fear of the thing as though it were Ebola or some totally devastating illness, when it’s actually going to be, for most people, something pretty manageable?
That’s definitely true. And I mean, speaking of Ebola, I also work on Ebola. A lot of the hysteria, it’s similar to what happened during the 2014 West African Ebola epidemic. This fear of people bringing it into the country. And, “We need to ban all travel from West Africa to West Africa!” The reality is that Ebola obviously has a much higher case fatality rate and is a much more severe disease for most of the people that get it. But Ebola is also much less transmissible. So, they are two different things, but people are responding to both with the same fear. And a lot of it is the messaging. I don’t know if you know that there has been an Ebola epidemic, occurring in the Democratic Republic of Congo, since 2018. And it’s the second largest after West Africa. And you know, nobody’s worried about that. Nobody’s talking about a travel ban or mandatory quarantines or anything like that. Because Ebola at this point is a little bit more familiar to people, I think. And we also have vaccines. And we’re testing therapies to treat Ebola. With this, it’s much scarier, I think, because everybody’s like, “You’ve never seen this before. It’s brand new. We don’t know how bad it’s going to be — we have nothing to treat it or prevent it.”
What do you make of the Trump administration’s leadership on this crisis?
I don’t have a lot of faith in the U.S. government’s response. It’s really dangerous, the way that President Trump is focusing on the stock market, tax cuts, or tariffs, or whatever, is missing the the level of concern that we should have. It has two effects. It seems like a lot of people are either like, “Who cares?” Or they’re, “Let’s start stocking my survival bunker.” Neither of those extremes are good ways to respond to an outbreak.
I also think that it is a terrible idea to put Mike Pence, who presided over a really large HIV outbreak in Indiana, in charge of these efforts. And also to restrict communications from NIH and the CDC so that they have to be routed through Mike Pence’s office. That is not the right way to make sure that people are informed and prepared and up to date about what is actually happening.
Is there one last thing our readers should come away with?
I would like to reiterate my message that people really need to be calm yet concerned. And to manage their worries, that this is going to be something that’s not going to kill everybody. It’s not. A two percent case fatality rate is significant, and that does mean that a lot of people would die if everybody became infected. But the reality is we just don’t know how many people are going to be infected. We do know, however, that there’s probably going to be more spread of this virus. So it’s just really important for people to prepare themselves as best they can, to minimize their own risks to themselves and their family — and to just try to approach this the way that you would a flu or a cold. I mean, I don’t remember people being this crazy during the 2009 flu pandemic. That had a much higher case fatality rate in some communities — from four up to almost 20 percent. So in that sense, this virus isn’t that different from other pandemic viruses that we’ve dealt with before.