Francis Collins speaks about the coronavirus, his faith, and an unusual friendship. | 2020-03-28 10:18:20 (Visits: 352 Times) |  | | NIH Director: ‘We’re on an Exponential Curve’
MARCH 17, 2020
Peter Wehner
Contributing writer at The Atlantic and senior fellow at EPPC
Editor's Note: The Atlantic is making vital coverage of the coronavirus available to all readers. Find the collection here.
“There are estimates that if nothing goes right and if we fail to flatten the curve and if health systems are overwhelmed, we might see the deaths of as many as a million and a half people in the United States.”
That’s what Francis Collins, the director of the National Institutes of Health, told me on Saturday. Collins is one of the most widely respected physician-geneticists in the world, who is deeply involved in containing the coronavirus pandemic. (Anthony Fauci, arguably the world’s leading infectious-disease specialist, works for Collins at the NIH and is a close friend.)
Collins was not offering a prediction, but a realistic worst-case scenario of what awaits America in the next eight weeks or so unless, in his words, we embrace “the more extreme version” of social distancing.
Read: The dos and dont’s of social distancing
“If you look at the rates of new cases that are being diagnosed, we’re on an exponential curve,” Collins told me. “That curve, some would say, places us only about eight days behind Italy. If that’s true, we have only a very short period of time before this becomes an obvious national crisis with many people presenting with serious illness and hospitals quickly becoming very stressed with the ability to handle all of these sick people, especially older people who are at higher risk and who may need not just a hospital bed but even a ventilator.”
I asked Collins whether that means we seem to be tracking with what happened in Italy.
“Right,” Collins told me. “If you look at the curve of new cases being diagnosed over the course of the last month, just look at the curve of what happened in Italy, and then look at our curve in the U.S., and you say if you go back eight days from today, they had about the same number of cases that we have today—that is, slightly over 2,000. And then if we follow that same track, then eight days from [March 22], we would be having the same kind of incredible crisis that they are facing.” (The New York Times described the catastrophe befalling Italy: “The coronavirus epidemic raging through Italy has already left streets empty and shops shuttered as 60 million Italians are essentially under house arrest. There are the exhausted doctors and nurses toiling day and night to keep people alive. There are children hanging drawings of rainbows from their windows and families singing from their balconies. But the ultimate metric of pandemics and plagues is the bodies they leave behind. In Italy, with the oldest population in Europe, the toll has been heavy, with more than 2,100 deaths, the most outside of China. On Monday alone, more than 300 people died.”)
Collins added this important qualifier: “Now we have a chance to change that, by applying now the most draconian measures on social distancing to try to limit the spread of coronavirus from person to person. But we will not succeed at changing the course from that exponential curve unless there is full national engagement in those commitments to try to reduce spread. I think we’re getting there; certainly in the last few days there seems to be a lot of waking up to just how serious the threat is, but that’s obviously not universal across this large and complicated country.”
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Since our interview, we’re seeing what “waking up” means in concrete terms: Ohio is postponing its presidential primary and ordering restaurants and bars to close as of 9 p.m.; Washington State and Maryland have announced the shutdown of restaurants and bars (except for delivery and takeout), and entertainment venues and recreational facilities. The new mandates from Washington’s Governor Jay Inslee will also require reduced occupancy for retail outlets. California called for all people 65 and older to shelter in their homes. In Los Angeles, Mayor Eric Garcetti closed movie theaters and gyms, while the Bay Area is in lockdown, requiring people to stay home except for essential needs. More than 30 states have closed down schools. The Centers for Disease Control and Prevention (CDC) recommended Sunday that no gatherings with 50 people or more—including weddings, festivals, parades, concerts, sporting events or conferences—be held in the United States for the next eight weeks. On Monday, it went a step further, saying we should avoid gatherings of more than 10.When I asked Collins what has surprised him most about the coronavirus from his perspective as a doctor and a scientist, he told me: “The degree to which this is so rapidly transmissible. More so than SARS was. SARS was a terribly scary situation for the world 18 years ago, but it never reached the level of infections or deaths that we have for this coronavirus, because it wasn’t as transmissible. SARS was transmissible but only from people who were really very sick. This one seems to be transmissible from people who have minor illness or maybe no illness at all—which is why it has been so difficult to get control or to know when you should be imposing these stringent measures we’ve been talking about. If you wait until you’ve seen lots of affected cases, you know you’ve waited too late, because the number of people who haven’t yet turned up in the health-care system but who are already infected is probably 100 times the number of cases you know about.”
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What’s being done to help hospitals that are being overwhelmed, I asked Collins, and what about the issue of ventilators and protective gear?
“There’s a huge effort to try to prepare for that in terms of inventories of personal protective equipment, the so-called PPE; there is a national stockpile, and we’re trying to figure out how best to distribute that where it will be most needed,” he told me.
“Every hospital is looking at what their capabilities might be and what they might have to do in terms of setting up additional facilities nearby. With universities having closed up for students, it’s possible we may need to see university space used as spillover for patient care. There are lots of concerns about whether there are enough health-care professionals, especially in places that were already short on physicians, like in rural communities. There is a major effort organized through [Health and Human Services], but obviously a lot of it is going to come down to what happens at the community level. And a lot of it will depend upon whether we’re successful in flattening that curve so that the need for intense medical attention stretches out over the course of several months as opposed to hitting us all at once in the next few weeks.”
Because we don’t yet have a vaccine, and we don’t yet have therapeutics that we know work, the best means of trying to prevent what Collins says “could be a really terrible outcome,” in addition to social distancing, is using sanitizers and washing your hands faithfully with hot water and soap for 20 seconds as many times during the day as you possibly can. “Those all seem like medieval practices, but they work,” he told me.
The soonest a vaccine will be available is in a year to 18 months, despite “being developed in record time,” according to Collins, so that’s off the table for now. (One vaccine began phase 1 trials in 45 volunteers on Monday.) More encouragingly, he said, “I would hope that the therapeutic aspects—most notably with a drug called remdesivir, which is now in clinical trials in China, Japan, South Korea, and the U.S.—will show that that particular antiviral has considerable efficacy for people who are very sick. That would help a lot if we actually had a drug that could be offered to people who most need it.”
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