Are We Headed To a Coronavirus Apocalypse In the Fall?

A laboratory technician of biotechnology company mAbxience is seen working, amid the outbreak of the coronavirus disease (COVID-19), in Buenos Aires, Argentina August 13, 2020. REUTERS/Agustin Marcarian
August 16, 2020 Topic: Security Region: Americas Blog Brand: The Reboot Tags: CoronavirusCOVID-19PandemicSchoolsFDA

Are We Headed To a Coronavirus Apocalypse In the Fall?

One former FDA head has some thoughts.

Those reopenings might have played a role in the virus sort of popping back up here, but it also helped the economy hopefully down the road.

Gottlieb: It wasn’t really the timing of reopenings. People said we reopened too early, and maybe there’s some truth in that. But I think the issue is more the speed of the reopening and how you reopened. You could have reopened early but reopened more deliberately and left certain things shut along a period of time. And so I wouldn’t say it was the timing of the reopening, that we reopened too early.

It’s the manner in which we did it.

Gottlieb: Yeah, exactly. And maybe that’s sort of baked in. When people say, “Well, we opened too early,” what they really mean is we reopened too quickly. But I think we should tease that out when we talk about it, because it’s important from a policy standpoint. Like, should we have reopened bars? No, we shouldn’t have. We should keep certain indoor congress settings that are purely for entertainment closed in perpetuity until we can figure out whether we have control. The priority should be trying to open the schools and do other things that are more important from a social standpoint.

Here in Connecticut, they’ve kept the casinos closed. They just don’t see a practical way to reopen those safely and not have those be a source of spread. And so you can make those decisions. It’s hard on the venues that ultimately are objectified and sort of carved out from the general reopening, but you do have to make those decisions. And the things that are the highest risk are indoor congress settings and confined spaces where you have a lot of mixing. And the ones that probably are the most suspect are the ones that are the indoor congress settings. We have a lot of mixing where it’s done just purely for entertainment purposes of individuals, is not really a sort of economic benefit that’s being derived societally, other than to the business that’s operating that space.

So when we decided to open the way we did, and you could say, when we decided to open bars, then it was sort of automatic that a lot of school districts were going to have some very difficult decisions to make this fall, because we are not going to just have 5,000 cases a day. We are going to have 10 times that.

Gottlieb: Look, I think we need to start making those hard choices and looking a month or two down the road about where we think we want to be. And certainly, as I said at the outset, I think you can make predictions a month or six weeks out in terms of how this is going to spread. And so we should have been more cautious about what we reopened to try to get more runway to reopen schools. Here in Connecticut — and again, I am working with the governor so I’m close to situation — they should be able to reopen schools for in-class learning. They’ll sort of give a flexible option to parents, but I think that the infection is under control.

They may not be able to keep schools open. There may be a point in time where there are outbreaks and infection picks up at a pace that you want to close the schools because you’re worried about children being exposed on a wide basis. But I think that you’ll have that opportunity at the outset, and the state took a lot of steps and incurred a lot of hardship to earn the right to have that optionality.

At the end of the day, as important it is to open schools, I think we do need to be mindful not to let this become epidemic in children because while I think that the clinical literature that says that this is less of a risk in kids is right (there are a lot of studies now that sort of affirm that), the information about whether or not kids can be conduits of spread is mixed. They’re less likely to get infected and less likely to become symptomatic. But when they do become symptomatic, they’re just as likely to transmit the virus, maybe more so because they compensate in behavior what they sort of lack in biology in terms of their ability to transmit it. So maybe they’re less biologically able to transmit it, but their behavior compensates for that. They’re more likely to come into contact with adults, and you’re more likely to hug and kiss your children when they’re sick. So they can be conduits to spread when they get symptomatic.

And then there’s the question of whether or not they develop severe disease: Certainly, there’s not as much evidence that they get can get as sick as adults and older adults. Certainly, the morbidity skews heavily towards older adults, but remember that not a lot of kids have had this. If you look at the CDC’s data — and I tweeted this out two days ago and I might get it wrong off the top of my head — I think they documented about 250,000 cases of kids developing symptomatic illness that was diagnosed. Not all of them were symptomatic, but most of them were because kids generally don’t get tested unless they’re symptomatic.

You have to put that against about 11.8 million kids in 2018–2019 that were projected to have symptomatic flu. Probably another three, four million at least had asymptomatic flu. And of that 11.8 million, that was a projection, but about 6.5 million actually showed up at the doctor’s office and got tested. So whatever way you want to cut it, whether you want to put the 250,000 against the 6.5 million or the 250,000 against 11.8 million, it’s an order of magnitude different in terms of the number of kids who got symptomatic flu and symptomatic COVID. And when you look at the data, there are 76 pediatric fatalities with COVID. That’s about the number of pediatric fatalities you see with flu. So people who say, “Well, this isn’t serious in kids, and flu is far more serious.” Flu grimly claimed a small number, an increment more lives in 2018–2019 in the pediatric population. But in effect with COVID, an order of magnitude more kids — I don’t think we want to see what it would look like. We should do everything we can to prevent an outcome where 11.8 million kids develop symptomatic COVID or even 6.5 million kids develop symptomatic COVID. I think that you will see some morbidity.

And just a final point on this: The one study — there are not a lot of good studies that look prospectively at the outcomes in kids — but the one study that CDC cites, and they have it on their website, is a study of 2,100 kids in China who developed symptomatic COVID. So they actually developed symptoms, most of them did. And they showed about 5 percent develop severe disease that created central hypoxia. They basically needed to be hospitalized and get oxygen. And 0.6 percent developed either shock or acute respiratory stress syndrome and multiorgan system dysfunction. So they were in the ICU, critically ill.

That’s a high percentage. It’s not nearly as high as you’d see in an adult population, but it’s still a high percentage, and still should give us caution about, again, just making sure we reopen schools with precautions in place so that this doesn’t become epidemic in children.

Mike, I want you to put the school reopenings in an economic context. But before you do, just briefly, how’s the economy doing? We had a really bad GDP report today, which everyone expected for the second quarter. There’s been some talk among economists that the V-shaped economic recovery is not happening, that the economy is sputtering. How do you see things?

Strain: Well, the economy is in very, very bad shape. Today’s GDP report shows the economy contracted by about one third on an annualized basis in the second quarter, which shows just how deep and how severe the recession was. That represents the worst quarter of economic performance since the US began keeping records in the 1940s. It’s surely the worst economic performance we’ve seen since the Great Depression. And it’s devastating. We’ve seen nothing like it in our lifetimes. The month that got the most weight in the second quarter GDP statistic is April, and April was a terrible, terrible month. The economy in June was already considerably outperforming the second quarter average. So the economy is much better than it was at its low point. The recession probably lasted two months.

The recession is probably over. But so much damage was inflicted in the months of March and April that, even though we climbed quite a bit — quite quickly in the months of May and June — we’re still in a very deep hole. We’re going to enter into a period this summer where we continue to see rapid improvement. But it’s going to take months and months and months and months and months of sustained rapid improvement until we’re finally back to where we were in February.