Epidemiologists
In The Spotlight
Pandemic Creates
An Unofficial Who’s Who In Epidemiology Today
No other event in our
lifetimes has called upon the knowledge, experience, and expertise of
epidemiologists as frequently as the COVID-19 pandemic. Everywhere we
turn, epidemiologists are forecasting estimated cases and deaths,
being interviewed on television, writing editorials and op-ed
articles, and answering questions for a wide variety of audiences.
Never have epidemiologists been in such demand, even though we have
more uncertainties than facts about the transmission dynamics and
other epidemiologic features and parameters of COVID-19 at this point
in time.
During these times,
some epidemiologists have become darlings of the media and some
considered heroes in providing reliable, objective, and trustworthy
information to an anxious public in various countries. Some have
generated many new followers on Twitter. In monitoring the pandemic
for our readers, we have collected a sample of contributions made by
epidemiologists around the world. It constitutes an unofficial Who’s
Who in Epidemiology today.
Value of Mitigation Applied Early
Britta Jewell,
research fellow in the department of infectious disease epidemiology
at Imperial College London and Nicholas Jewell, chair of
biostatistics and epidemiology at the London School of Hygiene and
Tropical Medicine and a professor at the University of California
Berkeley, provide a graphic display of the impact social distancing
can have, even if applied as little as one or two weeks earlier.
According to their calculations based on a model developed by the
Institute for Health Metrics and Evaluation, an estimated 90% of the
cumulative deaths in the US between now and August 2020 might have
been prevented by putting social distancing policies into effect on
March 2, two weeks earlier than March 16, when there were only 11
deaths in the entire country. They also utilize the natural experiment
of a delay of one week in Tennessee compared to Kentucky in
implementing lockdown measures to illustrate clearly the impact of
mitigation tactics applied earlier than later in an outbreak.
https://nyti.ms/2VDEyDZ
On CDC Disappearance
Thomas Frieden,
former CDC Director published New York Times op-ed on April 12, 2020
writing “The CDC has the knowledge and expertise to limit the spread
of the coronavirus, but it needs the authority and voice that‘s been
withheld from it the past three months. It is not too late to limit
the devastation of our nation’s health and economy. But the
administration must support and follow the guidance of the CDC—and it
must do so now.”
https://nyti.ms/2RNUP7X
Counting On Herd Immunity
Roman Prymula,
a respected epidemiology expert in the Czech Republic has made
headlines locally for making a surprising U-turn in favor of allowing
the population to return to normal gradually to enable a controlled
spread of COVID-19 and a gradual building of herd immunity while
continuing to protect the vulnerable groups. He based his change of
mind, as reported in the Czech media, because he believes China has
provided incorrect data and the death rate in Italy is lower than
initially calculated (not 15 percent but 2-3 percent). https://bit.ly/2Kggm5c
Straight Talk and Hard Truths
Michael Osterholm,
director of the Center for Infectious Disease Research and Policy at
the University of Minnesota writing in the New York Times opinion page
stating “It’s too late to avoid disaster, but there are still things
we can do. Our leaders need to speak some hard truths and then develop
a strategy to prevent the worst.”
https://nyti.ms/3eAm93i
Media Criticisms
Gregg Gonsalves,
assistant professor of epidemiology at Yale, was the subject of an
article at Fox News.com for criticizing New York Times reporters for
the headline of a story they wrote suggesting there was an unsettled
debate about the importance of testing for coronavirus. In an exchange
of tweets after the story ran, Gonsalves said “Your collective
reporting on the political aspects of this have been off-the-mark.
Everything is a Punch & Judy show, and the real story of the absolute
and continuing failure of the response to #coronavirus gets obscured
in your reporting as “who’s winning the day” in DC.
Need Infection Rate Information
Michael Mina,
assistant professor of epidemiology at the Harvard School of Public
Health and its Center for Communicable Disease Dynamics made a number
of observations about the pandemic during a conference call with the
media, according to the Harvard Gazette. Part of his advice was to get
folks out of nursing homes because he believes the virus is much more
transmissible than we have been able to document, and control in those
circumstances is “an extraordinary feat.” He added “We have to get to
an order of magnitude understanding of how many people have actually
been infected. We really don’t know if we’ve been 10 times
off or 100 times in terms of the cases. Personally,
I lean more toward the 50-100 times off, and that we’ve actually had
much wider spread of this virus than testing…numbers are giving us at
the moment.”
Government Fumbles
Larry Brilliant,
an epidemiologist who worked internationally on smallpox eradication,
co-founded Seva Foundation to treat eye disease in poor countries, led
Google’s philanthropic efforts at one point, and helped create the
movie Contagion to show what a serious pandemic could do to society
was interviewed on April 1 for a podcast by The Economist.
When asked if the
governments are taking the pandemic seriously enough, he replied “I
would say that governments have been incredibly slow in responding,
almost without exception. I think that your government in the UK [...]
began on a misguided mission to allow or think that they could allow
everybody or a large number of people to become infected, in an effort
to reach the epidemiologist’s Holy Grail of “herd immunity”.
I think my government
[in America] fumbled, almost unforgivably, in the way they mangled the
distribution of test kits; in the way that our leadership pretended
that the outbreak could be brought down from five to zero and it would
not be a problem after a while. And it continued to underplay how
important it was, as “a hoax,” until finally confronted with the stark
reality.” https://econ.st/2Kif4GK
Brilliant was also
interviewed for the podcast Soul of the Nation on a moral response to
COVID-19. https://bit.ly/3bjXwpP
High Profile in China
Zhong Nanshan,
is being called China’s leading epidemiologist sometimes referred to
as the nation’s “SARS hero” by Chinese media, according to The
Diplomat, a publication covering the Asia Pacific region. In 2003,
while SARS left China’s health authorities and government officials
struggling to rebuild public trust, Zhong was hailed for his
integrity. This was largely due to his public admission that the virus
was not as under control as state media portrayed.
The Diplomat reports
that “Despite his advanced age (born in 1936) Zhong has been appointed
to lead the National Health Commission’s investigation into the novel
coronavirus. By extension, he has become the de facto spokesperson for
any information related to the illness. Beyond his work tracking and
studying COVID-19, he has given multiple interviews to Chinese and
English language media. He is an obvious choice for the position, as
the Communist Party tries to highlight its efforts to manage the
crisis in a transparent, decisive manner…”
https://bit.ly/3eAnebm
Epi Predictions
Marc Lipsitch,
Harvard professor of epidemiology and director of the School’s Center
of Communicable Disease Dynamics has been in the news for the COVID-19
projections his academic group have provided that intermittent social
distancing may be needed until 2022. In an informative interview in
USA Today, Lispsitch said we’re in a dilemma—if we relax the
restrictions we can expect a resurgence, and if we keep the
restrictions in place it will be economically disastrous. What to do?
He thinks we can try to bring down cases in each locality to a point
where they can be controlled individually. But the epidemic will
likely appear in more than one wave and people are confused about that
thinking if you stop it once you’re done.
Asked directly, so how
long will people have to hunker down? Lipsitch said “It’s not a
scientific choice only. It’s ultimately a political choice, and
science is one input.” Asked, so how do you see things playing out,
Lipsitch gave his longest reply—
“If I had to make a
prediction about how the interaction between social and scientific and
public health factors will play out, I think there's going to be
fatigue at some point. Some places are going to let up either after
they've controlled the first peak or before they've controlled the
first peak. Cases will reemerge, and because people are so tired of
social distancing, it will take until the intensive care units are
overwhelmed in that place to get people to crack down again, and then
there will be some cycles of that. There are ways to try to avoid
that, but they all involve this very long and destructive process of
social distancing. It's easy to say as the public health person, this
is what we need to do for public health. But I'm acutely aware that
there are also other considerations, and I don't see a really good
answer.”
Controversy In Sweden
Anders Tegnell,
Sweden’s chief epidemiologist and reportedly the architect of his
country’s “social distancing light” or “soft” approach (allowing
population immunity to develop more naturally) has been fending off
critics. Sweden sought to shelter the elderly and vulnerable but has
left stores and offices open and waiting to see what happens.
According to the European Centers for Disease Control and Prevention,
Sweden has reported over 1200 deaths through April 16 compared to only
72 in Finland with half the population which is often used as a
comparison because it took more stringent measures in the Helsinki
area. Other Scandinavian countries have also reported significantly
fewer deaths with rates per 100,000 much lower.
Joacim Rocklov,
a professor of epidemiology at Umea University is quoted in the Wall
Street Journal saying “this is a big risky experiment with the entire
population that could have a catastrophic outcome…It is risky to leave
it to people to decide what to do without any restrictions…”
A recent op-ed in one
of the important newspapers by 22 physicians urged the government to
lockdown the country as is being done elsewhere. Tegnell has rejected
these arguments and has debated critics, according to a recent account
in Canada’s National Post. It concludes by saying about Tegnell, “One
wishes good luck to the temporary helmsman of the Swedish ship of
state as he argues that icebergs are not really his department.”
https://on.wsj.com/2RKqmru
Burden Unimaginable
After
offering to come out of retirement to help with COVID-19 control
efforts, Bill Hall's offer was immediately taken up by his
former health department. He told local media
“I am a roving epidemiologist. What that means is that
I’m available to travel to whichever district in the Eastern Region of
the state that is in the greatest need of epi manpower. According to
the paper Hall spends his days interviewing COVID-19 patients and
their contacts; trying to locate contacts who might have been exposed
to the virus; and doing patient followups, case reviews, case
monitoring, and data entry, among other tasks. Additionally, he
provides guidance to health care facilities and physicians about
testing criteria.
He said “The
burden created on the health care and public health system is
unimaginable…My hat just goes off to all the people who are doing all
this work.”
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