With news of a vaccine, we are looking forward to getting out and touring again. But what are the risks? Is it safe? Will we still need to wear masks anyway? The BGES Blog caught up with Dr. Gary Wilson to learn his take on the challenges and hopes as we enter into a new era of the Covid-19 nightmare.
BGES: Dr. Wilson, thank you for agreeing to talk with us. Tell us a little about your career and experience in infectious diseases.
GW: I am finishing my 45th year in clinical medicine. I trained, certified, and have worked in family practice, internal medicine, infectious diseases, critical care, nutrition, and various administrative/executive positions in healthcare organizations. My primary focus for the last 13 years has been clinical infectious diseases.
BGES: Tell us how the medical profession views Covid-19 and how that has evolved since its inception.
As has become common in our present society, I would say there is a diversity of views of the pandemic in “healthcare” that realistically ranges from practicing providers to administrators to business people to policymakers. It depends on one’s training, education, and present focus. I would also note there appear to be some generational differences.
Covid-19 is a fairly transmissible, primarily respiratory, viral infection that has found a highly susceptible world population. There is significant illness especially among older people, males, and people with underlying health issues—particularly cardiovascular problems, obesity, and diabetes, leading to large numbers of hospitalizations and significant mortality.
There is no present particularly effective treatment (think penicillin and strep throat). Prevention is the best strategy but requires aggressive social “distancing” measures. Most effective is least contact. Alone on a desert island is “best.” This strategy obviously has huge secondary social effects ranging from mental health to other medical care to economic to education, etc., etc. Finding the “right mix” is difficult in general and probably impossible in the sense of fusing diverse values. Medical “expertise” can only be one piece of the puzzle.
Widespread immunity, either natural (post-infection) or artificial (vaccination), is likely the “end game,” i.e., stopping the problem.
One clear “lesson” of the past year should be humility for all concerned.
BGES: How have your experiences and observations in practice been affected by the past nine months?
In one sense not much. Given the “facts,” this has generally been pretty predictable. In another it reinforces Von Moltke’s military-based truism: “No plan survives execution.” It is a constant adaptation, iteration. Facts today are rubbish tomorrow. To do the “best” we can is a “journey” of ever new challenges. Back to humility. I would also note this strikes particularly effectively at many of the weaknesses in our healthcare system and present society in general.
BGES: What will immunizations do for individuals? Will they still need to social distance or wear masks?
Immunizations will, hopefully, produce “artificial” immunity. Preliminary data suggests the first vaccines can do this for 95% of those vaccinated. It must be kept in mind the mechanism of these vaccines is new (no previous vaccine has used it) and the “fastest” vaccine from start to deployment historically is four years. If they work as planned, they will prevent or mitigate the infection for individuals, and if enough people are immune the pandemic will “die out” or become episodic for small numbers of people like many infections. It is unclear how many people will have to be immune to accomplish this. Historical, mechanistic predictions say 60% to 90% of the population. Presently, depending on one’s assumptions, our (U.S. population) figure is 15 to 150 million people may have some immunity. So say it’s 80 million, we need to vaccinate 100 to 210 million people to achieve the goal. The time to produce, deploy, give that number of vaccinations is not insignificant. And this all depends on “the plan surviving execution.” The vaccine may not work as well as predicted. Immunity may not last. Indeed if it significantly wanes in six to eight months, it may be impossible to ever use vaccination to suppress population infection to our goal. There will also be questions about individual decisions to take the vaccine. If 30% to 40% refuse, then the goal probably can’t be met with the obvious consequences. And we live in a world that includes more than the U.S. with ongoing travel raising other potential transmission, even “wave” questions.
Until the pandemic ends or is mostly suppressed, the social distancing issues remain very relevant. Even those vaccinated will not know their effective immune status. They could be in the 5% predicted not to get immunity or, after we vaccinate millions as opposed to a few thousand in studies, 95% may be optimistic.
BGES: We are anxious to resume touring. Will individuals who are immunized be able to mix with those who are not? Can an immunized person transmit Covid to one who is not immunized?
Mixing of immunized and unimmunized people is inevitable, even under best-case scenarios. It does appear possible vaccinated people may carry the virus, so making it possible to transmit it even if they are protected from serious illness. In the end, the amount of disease in the “community” and individuals’ “risk tolerance” will drive individual as well as general societal decisions.
BGES: Do you have any encouragement to offer BGES members for 2021? Is there anything to watch for?
2021 is almost certain to be better than 2020. How much and when is unclear. Staying abreast of current circumstances and thinking carefully including circumspect collection and weighing of “facts” will let each of us do the best we can.