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COVID-19: What Do We Have to Look Forward to?

What does the future portend?

by Eric Holdeman / September 3, 2020

Donald G. McNeil Jr. is the guy who makes me sit up and listen when he speaks about the virus. Yes, he is a NY Times reporter, but that means he is drawing his information from many, many different sources. He has reported on infectious diseases for decades, so he knows what he is talking about. 

He might not be right all the time, but I'll put my money on him!

 

‘Autumn really worries me’

As fall approaches in much of the world, many people are anxious about what will happen when cold weather forces people indoors. Will the virus resurge with a vengeance, especially as people return to offices and schools reopen?

 

To get a preview of the fall, we spoke to Donald G. McNeil Jr., The Times’s infectious disease expert, whose job has become envisioning the future of the coronavirus crisis.

We’ve been warned about a “fall wave” for a long time, but then we had a bad summer wave. What most worries you about the fall?

I try to avoid “wave” metaphors because each outbreak is unique. New York City and Sturgis, S.D., both had bad ones, but months apart and for different reasons: New York in February because of tourists returning from Europe; Sturgis in August because of a motorcycle rally where masks were disdained.

But yes, autumn really worries me. Outbreaks are exploding at colleges all across the nation. There may initially be fewer deaths because students are young — but professors aren’t.

And soon, chilly weather will drive people indoors, where studies suggest you are 20 times more likely to get infected. By midwinter, if we aren’t careful, the death toll could head back up toward its April apex.

How will celebrating the holidays be different this year?

No American wants to hear this, but experts say it probably won’t be prudent to have big indoor family gatherings for Rosh Hashana, Thanksgiving or Christmas. It’s sad, but I don’t see a safe option — especially for families with a child away at school. When college towns become epicenters, you really don’t want students to come home and unwittingly infect their families. And students need to consider this: Yes, it’s miserable to miss a family holiday — but could you forgive yourself if your grandmother died because of you?

What scientific developments are you following most closely?

Scientists I talk to are optimistic about monoclonal antibodies. One called them “convalescent plasma on steroids.” The best antibodies are cloned and grown in cell broths. Small doses might act like vaccines that protect for a few weeks. If they do, getting them to high-risk Americans — medical workers, nursing home patients and the families of the infected — could blunt the epidemic. But they can’t be grown in bulk quickly or cheaply, and F.D.A. approval for prophylactic use is uncertain.

President Trump has pledged to have a vaccine before the end of the year. Is that realistic, and if so, would there be safety concerns?

Vaccine experts I talk to are very nervous right now.

Actually, many of them believe that by late December or January, we may have solid proof that one — or even several — vaccines are safe and effective. That would be very good news.

What they fear, however, is an “October surprise,” the possibility that, to boost his chances on Nov. 3, President Trump could pressure the Food and Drug Administration to grant a premature “emergency use approval” for a vaccine. (The F.D.A. did that for hydroxychloroquine and convalescent plasma based on data that many scientists felt was weak.)

There are three ways that might happen:

The most shocking would be if the F.D.A. just used the Phase 2 and monkey data that it already has. But that’s what the Russians and the Chinese did, and it caused an outcry here. Americans might feel like guinea pigs, shun the vaccine and be angry at the administration for trying.

The second would be for the F.D.A. to pressure the trials’ data safety monitoring boards to divulge what they know. As a safety precaution, those independent boards look at partial data before the trial finishes to make sure no participants are being hurt. They normally keep anything else they learn secret. But if a vaccine looked even partly effective, the F.D.A. might approve based on that. However, experts think it is unlikely the boards will have enough data by early November. They also say that vaccine companies might actually fight an F.D.A. approval in court if they think it’s dangerously premature.

The third possibility would be that the Oxford/AstraZeneca vaccine, which started testing early in Brazil, gets approved in Europe by October, and the F.D.A. echoes the approval — even though the Europeans set a lower standard of proof than the F.D.A. did for American manufacturers.

“That’s what keeps me up at night,” one expert told me.

Is there any hopeful news about the virus that we can lean on as the pandemic carries on?

Yes, absolutely. I’m optimistic that there will be safe vaccines pouring out of factories by sometime next spring, and that this will all be over far faster than I expected just a few months ago.

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