Podcast: Infectious diseases expert on the current state of the novel coronavirus

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Jim Dryden (host): My name is Jim Dryden and I write about science at Washington University School of Medicine in St. Louis. I’m honored today to be hosting the launch of a new podcast called “Show Me the Science,” a brief podcast about the research, teaching and patient care as well as the students, staff and faculty at Washington University School of Medicine in St. Louis here in the “Show Me” state of Missouri.

Soon after a novel coronavirus first appeared in China in late 2019, researchers, doctors and staff here at the School of Medicine began preparing for the possibility of an outbreak. Today we begin updating you on those efforts with a conversation involving where things stand and where we might expect to move forward. We’re speaking with Steve Lawrence. He’s an associate professor of medicine and an infectious diseases specialist at Washington University and Barnes-Jewish Hospital in St. Louis. He’s also an expert in public health and epidemics and emergency preparedness is one of his primary interests. He has a master’s degree from the London School of Hygiene and Tropical Medicine, one of the premiere public health schools in the world. As we speak, we’re practicing some safe social distancing by doing this interview remotely.

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Dryden: So Dr. Lawrence, I don’t know about you but for me these last couple of weeks have been different than anything I’ve ever experienced. Now, you’re always on the lookout for these sorts of things but even for you this one has to be a little different, right?

Steven J. Lawrence, MD: You know this is something I’ve been studying, preparing for bioterrorism attacks or influenza pandemics and pandemics such as this for 20 years and it’s been something I’ve followed closely. I’ve helped our communities in the medical school be prepared for such things, however, this really is the most unprecedented type of event that certainly has happened in my lifetime and in nearly everybody’s lifetime who is alive today. The United States really hasn’t seen anything like this – actually the globe hasn’t seen anything like this since 1918, with the influenza pandemic at that time.

Dryden: As an institution here at the Washington University School of Medicine, how are the students and physicians and researchers responding so far?

Lawrence: The response has been phenomenal so far. As soon as we recognized that this infection was going to make its way out of China and spread around the world, we knew that we were going to be affected in our region as well. You know, we had plans in place for many years even before 2009 in preparation for an influenza pandemic and there are so many similarities that we didn’t have to start from scratch. You know, our goal is to be able to still provide care for all patients who are going to be sick and need care to help make sure that there are as few bad outcomes and deaths as possible as the outbreak continues.

A lot of the really fascinating and inspiring responses thus far has been from our medical students. You know our medical students have had their training curtailed through this. Now what that has led to, though, are a group of highly, highly motivated educated, talented and really spectacular people who have been on their own that formed a coronavirus response team and they have already – in just about a week and a half – started working on now almost a dozen different projects and activities that are helping to support the COVID-19 response. And these things include being able to provide childcare for health care workers in the region whose child care has been cut off because of the stay-at-home restrictions and this is helping to keep our health care workers working when they’re going to be most needed. They’ve been summarizing all of the rapidly published literature and the medical literature that has come out to be able to provide those to clinicians, and several other projects. It has been already dozens and dozens of, and probably now many hundreds of hours already that they’ve contributed to the response.

Dryden: In terms of you personally, so tell me what you thought when you first heard about this first in China and then as it began to spread.

Lawrence: The very first thoughts honestly were not of great concern because whenever there’s a new virus that is identified, it causes a few cases, raises some level of attention and people watch it for a while and most of the time they fizzle out. When this one clearly didn’t fizzle out and started to cause widespread infection within China, it really became clear that we were dealing with something different. And then so the next reaction was this sounds like SARS, but luckily not quite as fatal. The approach at that point was, well we were successful in 2003, stopping SARS with public health measures only – there was no vaccine there was no antiviral treatment. Aggressive testing and isolation of cases and quarantine of contacts we were able to stop the transmission of the disease within six months and it’s not been seen for 17 years. But then it clearly became that this was not going to be contained. And when we were seeing spread outside of China and rapid progression in many other countries, it really hits hard that the things that we’ve been training for and watching out for much of our careers – and in my case for 20 years – it’s really hitting home because this is, this is the real thing.

Dryden: What worries you, what concerns you most about this present moment?

Lawrence: I’m most concerned about how large of a peak we’ll see of sick patients and how long that will last. I think the most feared consequence of this epidemic is having a large number of sick patients presenting to our hospital and not having the staff, the stuff (basically the equipment like ventilators) and the space to be able to provide care at our usual levels of care and standards of care for everybody who needs it.

Dryden: Now this region did launch this stay-at-home policy much earlier than some other parts of the country that have many more confirmed cases. Does it have the potential to help and as health care leaders at Washington University, what are you saying to regional leaders about how these policies might, you know, as they say “flatten the curve?”

Lawrence: We hope that they will make a difference and believe that they will make some and we hope that it’s enough. And the decisions to pull the trigger early – earlier than some other communities on these aggressive, distancing measures, we will see. It’s going to take a couple of weeks – two or three weeks to know how effective they are and really see if it will be enough to blunt the impact of the high number of patients coming in. It also probably reflects a little bit of history. You might know that St. Louis in the 1918 influenza pandemic was known for adopting these measures very early and the end result was much more favorable than some cities that did not undertake these measures early on. And so if history repeats itself this will have been a very good decision and we just hope that it’s enough and soon enough and strong enough.

Dryden: This virus feels like what exactly? I mean, for example, most of us can tell the difference between a cold and influenza. If I get body aches, I know it’s probably flu, but with COVID-19 is there a symptom that’s a tip off or is it still so new that we just don’t know?

Lawrence: Unfortunately we can’t tell just from the illness if it is COVID-19 or if it’s one of the many other respiratory viruses that are circulating now and every year. When people do start to get sick, it may have more of a cold-like appearance with very mild symptoms. In fact sometimes people can be infected without any symptoms at all.

Dryden: As you know there was a recent study that showed that younger adults between 20 and 45 also seem to be at risk for developing severe COVID-19 disease. What does that mean for people in that age range and for public health efforts to control the spread right now?

Lawrence: There is greater risk in age 60 and over, however, as we learn more about this there are certainly instances where people even as young as in their twenties sometimes and rather infrequently can develop more severe disease. And so when we look at a virus that is likely to infect a significant portion of our population, you know we’re certainly going to see a noticeable number of younger people who do become ill simply because even a small percentage but with so many people who get the infection, even a small percentage will be a total number that’s pretty high.

Dryden: We’ve heard a lot about how to keep ourselves safe: Wash your hands regularly with soap and water, wipe off surfaces with bleach, stay 6 feet apart, avoid large groups, that sort of thing. There are already shelter-at-home orders in effect. Is that going to be enough?

Lawrence: Yeah, I think this is an approach of escalating the social distancing measures to be able to help blunt the rapid rise in the number of new cases. It may be necessary to go with even further restrictions but those types of measures might be necessary in multiple, if not all of the states at some point to be able to really flatten the curve. Again, these measures are needed because we talked a little bit about the likelihood of some younger people potentially having severe illness. We do know that a lot of younger people will be infected with mild disease and, you know, just very little illness at all or very mild symptoms, sometimes no symptoms. And in those instances there’s more of an ability to be contagious because they may not know that they’re sick and they may not know that they could pass it on to somebody who’s at much higher risk. And so all of these measures that are taken to try to limit the number of people interacting with each other are important to protect the public as a whole.

Dryden: How are you and your colleagues holding up?

Lawrence: You know I think everybody is getting a little bit tired. Hopeful, though that all of these efforts are going to make a difference. And that’s what I see every day. People still with a high level of energy. There’s a lot of commitment and real resolve and still drive and energy to be able to continue to work hard to put all of these measures into place to be able to maximize our response and minimize the effect of this epidemic as it unfolds.

Dryden: What about testing? I know it’s very important. Why is it so important?

Lawrence: Testing is important for a couple of reasons: One of them is to identify an individual patient who is sick and to determine if that’s the reason for it. Especially for those who are sick enough to be in the hospital. Part of that is that there are potential investigational treatments that can sometimes be used if we know that a patient has COVID-19. Another reason is because we would want to make sure they’re in a hospital room that is equipped to be able to prevent the spread of infection from them to either health care workers or other patients. And so that’s one reason. But there’s another reason for testing a little more broadly and as that capability increases, we’re able to get a better handle on how much infection there is in the community. I think though we do – regardless of having the broader testing within the community – it is an absolute expectation that we will see a relatively rapid acceleration of the number of sick patients here in our region just like every other place has seen. And we are very cautiously optimistic – I’m not sure optimistic would be the best term for it – but we’re keeping our fingers crossed that because we had a little more lead time to institute some of these measures of limiting public gatherings and trying to limit face-to-face meetings and a number of interactions, that we are hopeful that by instituting those earlier in the curve that we may be able to lessen the impact so that we don’t face the dire situations that are being seen in hospitals in Seattle and New York right now and and are likely unfolding and in other cities at the moment.

Dryden: Is there any evidence that COVID-19, like flu, might go dormant just a little bit as the weather warms up?

Lawrence: Well that would be great if it did but I don’t think we have any reason to believe that it will make a substantial difference. While there – if we’re lucky we’ll see a mild decrease or at least a faster control of it. But I don’t think that anybody would feel strongly optimistic that it’s going to just disappear. Now the other thing that we also have to brace for is if this does happen to have some seasonality to it that, even after getting beyond this wave of infections that will occur, will there be another one later on either in the fall or next winter? And I just wish we were able to see in advance so that we would know what to expect.

Dryden: Right. Would it be, though, perhaps if it did come back next fall or winter a case where there would be at least some immunity built up in the community at that point because folks had been infected now, you know? And not that that’s a good thing but some people, many people are infected and they’re sick but they’ve gotten better, they’ve come out the other side. Would they be protected next fall?

Lawrence: Yes, and absolutely that is an important point. We anticipate – although we don’t know with certainty, but if this virus acts like most respiratory viruses that we would expect people who are infected during this wave will be protected for future waves, particularly ones in the near future because then we have what’s called herd immunity. And ultimately when we do have enough people who are immune to this, then we would hopefully then not see any further large outbreaks that occur. And herd immunity can be acquired either by infection – and so people have been infected and then they’re immune, hopefully for life – but then also when a vaccine would be available, that would also allow for herd immunity if an effective vaccine is deployed that then the population will have enough immune people that it won’t take off with another epidemic wave.

Dryden: Ok. Thank you very much for your time. I guess we keep our fingers crossed and we make sure that before we cross them we wash them.

Lawrence: Definitely. Wash those crossed fingers.

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Dryden: Steve Lawrence is an associate professor of medicine in the Division of Infectious Diseases at Washington University School of Medicine in St. Louis. He’s been speaking to us as we launch our new podcast, “Show Me the Science.” The goal of this project is to keep you informed and maybe even teach you something that will give you some hope. For the foreseeable future we will focus on the immediate threat from COVID-19.

This has been “Show Me the Science,” a production of the Office of Medical Public Affairs at Washington University School of Medicine in St. Louis. I’m Jim Dryden. See you next time. Stay safe.

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