On Thursday, May 7, the leaders of the Arlington, Va.-based Infectious Diseases Society of America (IDSA), an association representing 12,000 infectious diseases medical specialists, epidemiologists, public health leaders, and other healthcare professionals, released a sternly worded statement calling on the White House to reconsider its reopening strategy around the COVID-19 pandemic.
Under the headline “With Lives at Stake, IDSA Calls on White House to Follow and Support the Guidance of our Nation’s Public Health Experts,” IDSA’s leaders insisted that “Strong and specific federal guidance is critical to protecting our country, our communities, our health and our lives in the face of the still escalating impacts of COVID-19 across the United States. Federal support for the testing, contact tracing, infection control, and medical equipment needed on local levels to control this pandemic will be essential. We understand the economic pressures to reopen, but until we have widely available effective treatments and a safe and effective vaccine, policies that promote physical distancing are our best defense,” the leaders declared. “When it is safe to reopen, state and local governments need specific, evidence-based guidance from our nation’s top public health agency outlining the steps necessary to keep our population safe.”
The statement was signed by Thomas M. File, Jr., M.D., IDSA’s president, and Judith Feinberg, M.D., chair of the HIV Medicine Association, an affiliated association.
This week, Dr. File, who has practiced as an infectious disease specialist since 1979, and who is chair of the Infectious Disease Division at Summa Health in Akron, Ohio, and chief of the Infectious Disease Section at Northeast Ohio Medical University in nearby Rootstown, Ohio, spoke with Healthcare Innovation Editor-in-Chief Mark Hagland, regarding the IDSA’s statement and its context. Below are excerpts from that interview.
Dr. File, what prompted you and your colleagues to speak out on Thursday?
Primarily because a lot of states had opened up the week before and others were about to open up over last weekend. And we wanted to ask about the impact on the incidence and prevalence of COVID-19, and would that pose a risk to public health? We’re not against opening up the economy at all; the issue is, as we do it, we have to be safe, and do it in a carefully planned, incremental approach.
If you go to our website, you’ll see that the day on which the White House Task Force posted on April 16, their plans for “Reopening America,” we published a statement on our website. So we wanted to reinforce the importance of maintaining some of these good-health practices. Until we have widely available antiviral therapy and a safe and effective vaccine, the best defense is physical distancing, wearing masks, hand hygiene, disinfecting surfaces, etc. And we’re quite concerned that even when we go to grocery stores, people are somewhat lax about wearing masks. And the message is that if I wear a mask, I’m protecting you. So the higher the percentage of the population wearing masks while in public, the more the infection rate will be reduced. And hair salons and other businesses are about to open up here in Ohio on Friday.
Does it bother you that even reporting on or discussing facts, has become politicized?
Oh, absolutely. And it shouldn’t be political. My goal as a physician is to give the best advice, to improve outcomes for our communities and for our patients, and not to be political. That’s certainly not our role. We just want to give good advice to policymakers, whatever their party affiliation is. This shouldn’t be political; the virus isn’t political.
With regard to COVID-19 itself, it seems like a particularly tricky or baffling disease in how it’s presenting, correct?
We’re learning a lot as we go through this. And it’s novel, which is the challenge. And as we treat more and more patients, we become aware that our initial perceptions have changed quite a bit. Even the CDC [the federal Centers for Disease Control and Prevention] has changed its “common symptoms” list. Even this presentation of multi-system inflammation in kids is rather new. And as we gain more knowledge about how to monitor and treat these patients, to try to reduce the burden of disease, we’re learning a lot more. When we put out our first guidelines for management and treatment, we didn’t have anything other than supportive care. Now, we’ve got Remdesivir, but only in the states with high volumes of cases; but we don’t have access to it in Ohio, because we don’t have a high number of cases.
A lot of Americans are becoming impatient with some of the restrictions, and that’s really unfortunate.
Yes, it is, and that’s difficult; but we have to rely on the goodwill of the patients and population. They have a big responsibility to do this effectively, so it doesn’t cause a backlash. Because if that happens, it will be even worse for the economy. So there has to be a balance between public health and the economy. We just want to make sure to keep a balance. And as we open up the economy, we can’t diminish these good-health practices. And we just have to keep sending out these messages. And that’s why we wanted to send that message last week.
You’ve heard about the restaurant in Castle Rock, Colorado, that reopened and allowed swarms of patrons in at once, and then was closed by public health authorities?
Yes, I’ve heard about that. Obviously, there will be a certain percentage of the population that will not adhere with the appropriate precautions that we’re recommending; but they have to realize that they’re putting not only themselves in jeopardy, but those around them. One thing we’ve learned tis this is much more transmissible than the flu, and even more transmissible than SARS or MERS. And we have to rely on the population to be responsible. Everybody has to take responsibility, or we run the risk of a backlash; certainly the restaurant owners don’t want that. I have to commend our governor and our Ohio Department of Health; they’re doing it slowly. As of Friday, restaurants can open, but only outside. They have to have distance between tables. And then in a week, they’ll be able to open inside, but with barriers. Hopefully, people can understand that we’re recommending this to be done in this planned show fashion, to protect them. And by not complying, they put the rest of the population in danger.
Can you speak to that differential in risk regarding outdoor versus indoor restaurant dining?
Part of the issue is that the level of risk depends on the ventilation inside a room; the air droplets probably stay suspended in air for a matter of hours, before they settle down. Outside, it will be much less time before they’re dispersed.
Most outdoor restaurant dining, with appropriate spacing put in place, will be OK, then?
Yes. These air droplets I produce, even when I speak, they travel three to four feet; if I sneeze, they go six feet. So if you’re beyond 6-8 feet, you should probably be OK, with this infection. Other diseases like tuberculosis or measles are airborne, and can go 100 feet.
Are hospitals handling this situation well overall right now?
Yes, the hospitals that were really stressed had a lot of cases over a very short period of time. We did not have that, we had a gradual increase and are actually seeing a decrease right now. We were never in a surge or overwhelmed. And we were never short of having appropriate masks or gowns; probably it was closest with gowns, but last week, we got a fairly large shipment of gowns. But if you look at New York, or particularly China or Europe, a large percentage of those infected were healthcare providers who lacked good PPE. And as we go forward, one of the crucial areas will be identifying infected patients and then doing contact tracing, is to make sure we ramp up the supply chain for PPE, because there will probably be local outbreaks; so we need to make sure there are enough masks, gowns, and face shields that can be transported to those places. Studies show that if we appropriately use masks, gowns, and eye shields appropriately, the risks are minimal.
And you weren’t crushed where you were, as hospitals were in New York City?
That’s right.
In your view, is it inevitable that we’ll have a huge surge in the fall?
I think it’s inevitable we’ll have a surge; I don’t know how huge it will be. It will depend on well-planned policies, especially around the return to school and work. For kids in school, it will be very difficult to explain and maintain compliance, and we just need to know more about the epidemiology of children and what their role is infecting adults. You hear anecdotally that it’s not very big; but children certainly do for influenza and other respiratory illnesses.
Do you think college students will be OK?
We’ll just have to wait and see how the activity goes, over the summer. Whatever happens in fall or late summer will depend on what happens in early summer and what we see with the numbers of cases ongoing. I still think there will be a lot less in-class instruction; students may be on campus, but they may be distanced more.
And until we get a vaccine, we’re going to have to do things differently.
Do you believe that it’s reasonable to anticipate that a viable vaccine will be created by next spring?
With the technology now, I think it’s feasible. Potentially, January is feasible.
