The Westerly Sun
As coronavirus disease 2019, or COVID-19, continues to spread, teams of doctors and public health officials in Rhode Island are tracking the virus. In an interview with The Sun last week, Dr. Selim Suner, Brown University professor of emergency medicine, discussed the nature of the disease, preventive measures, and the state’s response to the outbreak.
Suner directs the university’s Disaster Medicine and Emergency Preparedness division and has had extensive experience in disaster medicine, including the World Trade Center attacks and Hurricane Katrina. He also serves as chairman of the Rhode Island Hospital Emergency Preparedness Committee.
The Sun: Can you explain the biology of the coronavirus?
Dr. Suner: “There are different types of coronaviruses and they’ve been around for a long time. There are several coronaviruses that cause an infection in humans already, before this novel coronavirus showed up … This novel coronavirus, we think, came from an animal source. The predominant evidence so far shows that it originates in bats and may or may not have an intermediary reservoir before hitting humans. Humans subsequently contracted this virus either by being in contact with bats or through an intermediary, perhaps eating or touching another animal. And what happens with these viruses is, viruses mutate frequently. They evolve. One of the evolutions of this virus made it so that it likes infecting humans, and that’s the novel coronavirus.”
The Sun: How does the coronavirus infect humans?
Dr. Suner: “Each different type of coronavirus has different proteins that determine what it binds to in the human body, to get into the body and start causing an infection. This novel coronavirus seems to have a predilection to binding to some of the receptors in the lung and causing an infection that resembles viral pneumonia.”
The Sun: Chinese authorities first recognized the coronavirus in Wuhan, China, in December 2019. When did scientists in the United States begin to be concerned about the disease?
Dr. Suner: “It was probably a week or so after the first reports came out and then reports of more cases in hospitals were announced. That’s when we started to get a little bit concerned. Our radar screen was picking this up now, and we started talking amongst ourselves in the preparedness community, ‘Hey what’s going on here? Let’s get some more information.’”
The Sun: Is the coronavirus now considered to be a pandemic?
Dr. Suner: The declaration of a pandemic comes from the World Health Organization. They control the nomenclature of ‘pandemic.’… It’s somewhat semantics. We know that this outbreak has broken out of China, it’s all over the world, it’s infecting multiple countries, every continent except Antarctica, and there are cases of community transmission in multiple places … At this point, whether you call it a pandemic or not doesn’t really matter. We’re planning as though this is a pandemic.”
The Sun: Is it true that some people are more susceptible to the coronavirus than others?
Dr. Suner: “The data that’s coming out is very preliminary and it’s coming out fast and it’s not completely peer-reviewed. There are a lot of data coming out, but looking at a large cohort of patients, over 70,000 from China that was reported in the medical literature, we’re seeing some patterns. The most important of those patterns is that elderly people over the age of 60, 70, have a much higher burden of severe illness and death and those with co-morbid diseases such as diabetes, heart disease and smokers seem to be affected disproportionately severely from this illness. And kids are spared. They have sub-clinical illness, which means they don’t show many symptoms, if any at all. They may spread the virus without showing any symptoms, but they don’t get very sick and they don’t die.”
The Sun: I have read that the virus does not like warm weather.
Dr. Suner: “That’s, I think, more of a myth at this point than reality. We just don’t know.”
The Sun: What about coronavirus testing? Is it now available to everyone?
Dr. Suner: Initially there was a test in China, developed by the Chinese. Once they sequenced the genome of this virus, they were able to create a test to look for the virus and they used it there in large numbers. In the United States, the CDC [Centers for Disease Control and Prevention] worked with manufacturers to develop our own test and there were some delays in getting that test out to the states, so the CDC was the only place in the United States that testing could be performed. And the people who were to be tested was very strictly controlled by the CDC. They had to meet strict criteria… Now the states, including Rhode Island, have their own testing capabilities and these capabilities are being ramped up, but again, that is not happening rapidly. The number of people being tested is still very low.”
The Sun: Is there anything new to prevent the spread of coronavirus or are you still recommending basic sanitation?
Dr. Suner: “The basic sanitation measures may seem simple and not effective, but they are probably the most effective measures that can be taken. Hand-washing, limiting our interaction with our environment in terms of touching things and then touching our faces, putting a distance between ourselves and sick people, not hand-shaking, those types of measures are not technologically based, they look like old school, but they work very well in terms of limiting the spread of illness.”
The Sun: Is there a statewide plan?
Dr. Suner: “The plan right now is to screen for this disease in populations, identify people who have this disease and isolate those people … The other thing we worry about is there may be people spreading the virus who are not symptomatic or not coughing and don’t look sick. So if that’s the case, these measures of identification and isolation would be very difficult to do. That’s why, if everybody washes their hands, does some social distancing and not touching their faces, that doesn’t depend on testing anybody …we’ll really dampen the effects of this outbreak.”
The Sun: But, despite that advice, people are still panic buying items such as face masks.
Dr. Suner: “We see these pictures of people wearing masks on the streets coming from Asia. You know, Wuhan city was a completely different story than what we had in the United States when it first happened. There was widespread disease in Wuhan, so under those circumstances, the use of masks may have had some effect and that could be argued as well. But in the United States, healthy people wearing a mask on the street has really no effect in terms of protecting them from getting the disease. They’re probably going to get the disease not from their mouth, but from touching something with their hand and rubbing their eyes. Now, if someone is sick and they’re coughing and they wear a mask when they’re in a gathering with people close to them, within 6 feet of them, then that’s helpful — not for the patient wearing the mask but for everybody else around them.”
The Sun: What about a vaccine?
Dr. Suner: “That’s going to take a year, year and a half before we have that available.”
The Sun: What is your work, right now, involving this virus?
Dr. Suner: “Lifespan has created a task force for planning and responding to the outbreak, and our work involves looking at all our health care areas, first and foremost assuring the safety of the patients that come into our facilities, and our staff, and that means having enough equipment and supplies in terms of personal protective equipment for the health care workers and policies like, what do you do in the waiting room? Should we allow lots of visitors into the hospital? We’re trying to curtail visitation right now to protect the patients. And then, we’re looking into the future. What if we have widespread illness in Rhode Island, in the United States? How would that look in terms of the number of patients coming into the hospital? How would that look in terms of our capacity to treat these patients? What additional resources do we need? How do we get them? … And that’s a huge task. Lifespan has multiple hospitals … And we’re working closely with the department of health.”
The Sun: How many people are on the task force?
Dr. Suner: “Now, we probably have dozens if not 100 people working on this on a daily basis.”
The Sun: Do you feel confident that the virus can be brought under control?
Dr. Suner: “Large, widespread community transmission is not here. People should go about their normal daily life. There’s no need to cancel any large gathering events … If you’re going out to your child’s hockey game or whatever, just be cognizant of your surroundings. Who’s next to you? Are they coughing? Do they look sick? Wash your hands. Distance yourself from others. Stop shaking hands. Elbow butts are good.”