COVID-19 Questions Answered: IVAC-Affiliated Experts Give Their Take on the Challenges with Infection Control

Photo: Tim Kelley

As coronavirus-related facts change by the day or hour, International Vaccine Access Center experts in epidemiology, vaccine development, economics, policy, and behavioral science are called upon to analyze current events and predict what’s ahead. 

Here is a round robin on the latest with the pandemic and what our people are doing to support a rapid global response.

What will the spread of COVID-19 look like in less developed countries?

William Moss, MD, MPH
Executive Director, International Vaccine Access Center

We have no reason to think SARS-Cov-2 will spread any differently in less developed countries. We know influenza viruses are transmitted in very rural areas of sub-Saharan Africa and the SARS-Cov-2 virus is more contagious. My concerns are the spread of SARS-Cov-2 in densely populated urban slums, where people have little access to proper hygienic measures and social distancing, and the overwhelming of health care systems in less developed countries with little surge capacity. These are also settings where testing may be severely limited and thus many cases may go undiagnosed.

How can countries like the U.S. support other countries to slow the spread of COVID-19?

Ideally, the U.S. would serve as a model in how to slow the spread of COVID-19, particularly in being honest and transparent in communicating the risk to the population and in demonstrating the value of social distancing, hand washing and other preventive measures. Given that the U.S. health care system may be overwhelmed, with shortages of essential supplies, I unfortunately do not see the U.S. playing a big role in providing material supplies and on-the-ground technical assistance. Perhaps this is a role China can begin to play. That said, I hope the U.S. can be a leader in developing vaccines and therapeutics to eventually be used throughout the world.

When can we expect international travel to return to normal?

This is impossible to say. If social distancing and other efforts “flatten the curve” by spreading transmission out over a longer period of time, as I hope they do, we may be facing ongoing transmission at least into the next year if not longer. 

Do we know if COVID-19 will be seasonal like the flu or endemic like measles?

We do not yet know whether this disease will be seasonal or not, nor whether transmission will become endemic. The fact that the virus is transmitted around the world right now, in both the northern and southern hemispheres, suggests this virus does not need a specific season for transmission.

Why is social distancing critical in the U.S. and other places during the early stage of outbreaks?

Shaun Truelove, PhD
Assistant Scientist, International Vaccine Access Center

Text Box: Figure 1. Patan Hospital
Patan Hospital, Nepal (Photo: Amanda Mustard)

Social distancing is a public health practice that aims to prevent sick people from coming in close contact with healthy people in order to reduce the spread of the disease. It can include large-scale measures like canceling group events or closing public spaces, as well as individual decisions such as avoiding crowds.

Among multiple COVID-19 efforts, scientists in the Bloomberg School’s Infectious Disease Dynamics group is working with several state health departments to conduct COVID-19 transmission modeling scenario projections that estimate how many people will be infected, hospitalized, need ventilation, and die. The major unknown factor in our scenarios is how much people change their behavior and how effective these various interventions will be with this novel pathogen.

What we really want we need to do is reduce transmission early to reduce the speed of the outbreak. Even if we assume every single person will get infected, we want to spread it out over a much longer timespan, maybe even years—versus two months.

Too many cases in a short period of time could overwhelm the health system, and this would have a major impact on general care. If health providers aren’t available, people won’t get prenatal care, vaccinations, or care for chronic conditions that they need.

Canceling mass gatherings is really important—sadly, for me, even March Madness!

How close are we to a COVID-19 vaccine?

Jessica Atwell
Assistant Scientist, Center for Immunization Research / Center for American Indian Health | Department of International Health, co-instructor of Vaccine Development and Application and Good Clinical Practice: a Vaccine Trials Perspective

Text Box: Figure 1 .Staff nurse, Jinti Gogoi, prepares an injection of pentavalent vaccine at Assam Medical College, Dibrugarh.
Staff nurse Jinti Gogoi prepares a vaccine in Assam, India (Photo: Monica Tiwari)

Vaccine development does not happen quickly. The vast majority of candidate vaccines do not make it through clinical trials; very, very few (less than 1 in 100) ultimately get licensed.

We have a difficult time making vaccines for respiratory viruses like influenza or those that cause the common cold. There are a number of reasons for this, but one key factor has to do with our body’s own ability to generate long-lasting immunity to the pathogen. If natural infection with a virus does not lead to lasting immunity, making a vaccine that can do so is, in principle, very challenging. Many respiratory viruses, like flu, also change frequently; they’re a constantly moving target. Luckily this is not the case for Coronaviruses.

Amazingly, there are many groups already working on vaccines for SARS CoV-2, the virus that causes COVID-19. The first studies involving human subjects began in mid-March 2020. New technologies combined with incredible scientific innovation and dedication, as well as substantial political will (and funding) may help us shorten the usual timeline of vaccine development in this case, but I would not expect there to be a licensed vaccine in 2020. 2021 would still be an incredible feat.

That said, we may well have therapeutics such as antivirals or other medications that can decrease the negative effects of COVID-19 more quickly. For many reasons, they are easier to develop and test than vaccines. While these will not prevent infection, they may help reduce severe illness and death.  

How can we equitably distribute a COVID-19 vaccine, once it’s available?

Naor Bar-Zeev
Deputy Director, International Vaccine Access Center
Associate Professor, Johns Hopkins Bloomberg School of Public Health

As vaccine manufacturing is ramped up, initial batches of vaccines will become available but at insufficient numbers to meet demand. It is likely that first-line health workers will be prioritized, followed by other critical members of the workforce.

Countries that may have the highest mortality burden are likely to be the very countries that currently have not yet implemented testing. This is a tricky situation because places that lack resources won’t test as many people. Without enough testing these places won’t realize how many people are sick and it’s likely those places have the highest amount of infected people.

What can health systems or government agencies do to minimize economic costs associated with a new outbreak like COVID-19?

Bryan N. Patenaude
Assistant Professor of Health Economics
Department of International Health | Johns Hopkins Bloomberg School of Public Health

Text Box: Figure 1. This illustration, created at the Centers for Disease Control and Prevention (CDC), reveals ultrastructural morphology exhibited by coronaviruses.
CDC illustration of the coronavirus 

Governments must facilitate rapid testing, monitor and report fevers, and quickly isolate cases. I could envision a mobile application for COVID-19 tracking where individuals self-report fever via a temperature reading. The app could provide notifications for individuals to self-quarantine or instructions on where and how to get tested get tested, and it could help to identify cases in real time before people go to health facilities. This could help curb transmission. 

What is the short and long-term economic impact of COVID-19?

In the short run, a decreased demand for certain services due to social distancing and the closing of workplaces globally will have immediate impacts on the economy. Additional costs accrue from event cancellations and the lost revenue those events bring to surrounding communities. COVID-19 also appears to have a fairly high case fatality rate which means lives are cut short prematurely resulting in potential productivity loss to the economy.

COVID-19 is impacting many sectors but service sectors seem particularly hard hit due to a drastic decrease in demand spurred by social distancing. Additionally, businesses with large numbers of concentrated workers including factories where telework is not feasible may face significant revenue losses due to closures. What the long-term impact of these closures are on the economy will depend greatly on the duration of closures, the amount of time it takes for containment and a return to normalcy in terms of demand, and what the government does in the meantime to prevent individuals companies from being unable to meet their financial obligations. 

How does staying up-to-date on available vaccines impact a health systems ability to handle the influx of COVID-19 cases?

This is very important from a health and economic perspective. At IVAC, we’ve estimated that across 94 low- and middle-income countries, the use of 10 routine childhood vaccines are expected to avert $US 6.6 billion in medical treatment costs over the next decade—and secure more than $US 700 billion in economic benefits.

What can countries do to protect older adults?

Lois Privor-Dumm
Director, Adult Immunization | Policy, Advocacy and Communications
International Vaccine Access Center

Older adults are disproportionately impacted by COVID-19 and countries must consider all strategies to protect them, including social distancing, identifying and isolating infected individuals, and providing supportive treatment. Further, when an older adult is stricken with COVID-19, it not only effects them, but their families and the broader economy—something that rich and low-income countries alike need to avoid.  

Vaccines against influenza, pneumococcal disease, and herpes zoster could lessen the potential impact of health threats such as COVID-19. Influenza vaccines, for example, could reduce the risk of cardiovascular or other events that may lead to a decline in functional ability and greater likelihood of a severe impact from COVID-19. These vaccines, however, are not available in every country and immunization rates can also be suboptimal.

Immunization with pneumococcal vaccines, even in children, may contribute to a lessened burden of co-infections through reduced transmission, thus, vaccinating both children and adults makes sense. 

In the long term, vaccines should be developed with a target product profile that meets the needs of the most vulnerable:

  • Older adults who experience immune senescence, and
  • People in developing country settings, where health systems may not be able to support vaccines that are complex to store or deliver

Further, few countries have available platforms to deliver vaccines to older adults. There is no Expanded Programme on Immunization (EPI) for this group. It is uncommon to find providers who see healthy older adults and specialists who see adults with underlying illness don’t often vaccinate them. 

How do you talk to your kids about coronavirus?

Rupali Limaye
Associate Scientist, IVAC | Department of International Health

Patan Hospital, Nepal (Photo: Amanda Mustard)

If questions come up from children, address them plainly and succinctly. Don’t give extra details. We have a tendency to over-explain and over-rationalize (the same goes for discussions with caregivers related to vaccine confidence—that’s why the CDC and WHO recommend providers take what’s called the presumptive approach, in which they announce which vaccines a child needs without posing a question).

Be direct, answer the question, and be as reassuring as you can be.

How do you convince people that social distancing is important for them to adhere to?

I’m getting a lot of questions about social distancing. Social distancing and its interpretation is very much governed by the country you live in and the ideals the country is supposed to uphold. Singapore and Hong Kong are much more communitarian countries—in the U.S., we take an individualist perspective on everything. As a result, people have very different views on what social distancing means to them – which makes it challenging to implement as a global response. 

I would suggest that you only leave your house if you absolutely have to. If you go to the grocery store, wipe down everything, including bags. Otherwise, enjoy time with your family. We don’t usually have this time!

Check in with loved ones—call and FaceTime. Make sure people are mentally doing ok.