Epidemiologist sees agony giving way to hope

HANOVER — The nation’s success in following health recommendations, as well as watching what happens as China ends its lockdown today, will help to determine what is in store for the world during the coronavirus pandemic, according to Dr. Daniel Lucey, an expert in international epidemics.

Discussing what is known about COVID-19 in a webinar sponsored by Dartmouth College’s Geisel School of Medicine, Lucey told some 1,200 viewers that the lessons from previous viral cases provide important insights into this coronavirus, but a lot remains unclear, such as the implications for pregnant mothers.

During a question-and-answer session at the end of Tuesday’s webinar, Lucey said the studies of pregnant women are ongoing and, although there are no special concerns “that we know of, we don’t know enough.”

Lucey, who got involved in epidemiology during the AIDS crisis, helped doctors in Sierra Leone during the ebola epidemic, which is when he said he learned the importance of personal protective equipment, or PPE. He has stressed the importance of stockpiling respirators and other protective equipment since that time, anticipating future needs.

He has been involved in educational presentations that stress the need for individuals to be prepared to do what they can to prepare for pandemics, but said the current one is the biggest problem he has seen because of its ability to spread in a world where no one has any prior immunity.

Having been involved in health efforts during the SARS and MERS epidemics, Lucey stressed the importance of sharing information. He credited Li Wenjiang, the 34-year-old Chinese doctor who later died of COVID-19, with trying to alert the world when the virus first appeared in Wuhan last year.

The virus was able to spread quickly to the rest of the world because Wuhan was a center for high-speed trains and an international airport. It was not until Jan. 20 that China acknowledged that the disease could be carried, and not until Feb. 14 that it admitted that 1,716 health care workers were infected.

Lucey was alerted early by colleagues in Hong Kong who were concerned from the beginning and posted an alert about the disease on Dec. 31. Lucey had been scheduled to speak to the United Nations on SARS on Jan. 14, so he altered his webinar to discuss the new disease which wasn’t confirmed to be a coronavirus until Jan. 25.

Right away, Lucey said, he was concerned about making Africa a priority because the southern hemisphere is moving toward winter, when the virus can prove to be most deadly.

Meanwhile, he traveled to Hong Kong, hoping to get to Wuhan to work with doctors there. He could only get to Shanghai because of China’s lockdown, and he went on to Cairo to gather information there.

Feb. 14 was a turning point for Lucey because, once China admitted that health care workers were contracting the disease, he said “the implications were staggering” in terms of the likely shortage of PPEs, training, and crisis care planning.

Reasons for hope

Despite the slow start in preparing for the pandemic, Lucey said there is hope in the number of countries working on drugs to prevent and treat the disease.

By the end of the month, and possibly as early as next week, China will announce the results of its studies involving the use of the drug Remdesivir. While there is not enough information to vouch for their effectiveness, Hydroxychloroquine and Azithromycin are being provided to COVIC-19 patients in hopes that they will help with the symptoms.

Lucey said there also is hope that blood-plasma from survivors will be able to help those who are very sick, and further down the road, monoclonal antibodies from the B-cells of survivors may specifically target the coronavirus, he said.

Meanwhile, there also are several candidates for vaccines that may help. While he is a big fan of vaccines, Lucey cautioned that it is important to learn how safe they are and how to communicate that safety to the public.

April and May, he said, will be months of agony moving to hope as the Food and Drug Administration determines whether to grant emergency use authorization for antibody tests to determine not only whether people have fully recovered, but also the extent to which the virus has spread throughout the population.

Lucey believes it will be toward the end of May before the number of cases begins to fall, and that the disease is likely to return after moving to the southern hemisphere.

“I anticipate year-round transmission,” he said, “especially this first year, because no one has immunity.” How long immunity will last is another question. “I wouldn’t count on lifelong immunity,” he said.

He made a reference to the Babylonian king Belshazzar, who saw a handwritten message on a wall, but was unable to understand what it said. “If we can’t read the writing on the wall, and keep physical distance, if we can’t do everything we should do, then we will suffer the same fate as the Babylonian king,” Lucey said.

The webinar was co-sponsored by the Guarini School of Graduate and Advanced Studies, Thayer School of Engineering, Tuck School of Business, and the Dartmouth College Office of Alumni Relations.