Curran on coronavirus

James Curran led the nation’s fight against HIV/AIDS from its earliest days from his post at the Centers for Disease Control and Prevention. During his 25-year tenure as dean of the Rollins School of Public Health, he has witnessed outbreaks of MERS, SARS, Ebola, and Zika. He talks about the current COVID-19 pandemic.

You have said before that nothing scares you more than influenza. Is this coronavirus pandemic as alarming as a flu pandemic?

Yes, I think so. The reason respiratory infections that are readily transmitted are so scary is they can rapidly spread from person to person, community to community, and country to country. It’s especially scary when people who have minimal symptoms or who are asymptomatic can become infected and transmit to others. The HIV epidemic, in contrast, was much more difficult to transmit, but there were millions and millions of people infected before anyone even knew the virus existed. And the infection lasts for life with HIV. The benefit of coronavirus and influenza is, if you can find it early, you only need to isolate people for a short period of time unless they become seriously ill. But it requires a much more rapid response, and virtually everyone in society is at risk. You can’t limit it to a set of behaviors, since we are all breathing all the time.

What has surprised you about this virus?

Our previous experiences with coronaviruses included those which are transmitted easily and cause something akin to the common cold or those that caused serious illness but were not easy to transmit, like SARS and MERS. COVID-19 is a combination of rapid and ready transmissibility along with a very severe illness causing death.

How would you judge our nation’s response to the pandemic so far?

The unavailability of rapid testing very early, although understandable because it’s a new virus, really hurt us from being able to identify infected people, prioritize medical care, isolate people who are infected, and test their close contacts.

Once the US started to take this seriously, we’ve seen a community-wide response, bringing together the private sector, the public sector, the business community, and citizenry to socially distance and take other precautions. Social distancing is absolutely necessary, but it’s a blunt instrument when it comes to prevention. There has to be rapid availability of testing, and it can’t involve waiting several days to get results.

How soon do you think we’ll have vaccines and treatments available?

There are vaccine trials going on already. That’s very encouraging for this early. Contrast this with AIDS, where it took almost two years for the virus to be discovered and four years for a test for the virus to be available. And here we are only months after first cases were reported, and we’re already testing vaccines.

As far as treatments, back when I was in medical school, we used to say, you can’t treat a virus, you can only treat bacteria. Now there’s a whole wide variety of antiviral drugs, including those for HIV, hepatitis C, and influenza. That makes us more optimistic that we can develop treatments, but they still have to be studied in trials to show they are safe enough and effective enough to warrant widespread use.

Why have other countries been able to flatten their curves but the US is struggling to do so?

We don’t have a national health system. We have a federalist society that allows state and local governments to define their own capacity in public health and the private sector to define how health care is paid for, so there is no natural coordinating body like a minister of health, for example, that exists in other countries.

We have enormous capacity for health care. We have many of the very best hospitals in the world. We have tremendous scientific capacity to develop new therapies and vaccines. But, because of our federalist system, we are not able to respond as rapidly and consistently as more centralized democracies.

In addition, state and local public health has been allowed to erode over time, for budgetary and other reasons, so it’s very difficult to pull the kind of response together in the US that we’d like to see.

What advice do you have for the Rollins community?

Those of us in public health should lean in. We understand this. We’ve trained for this. This is our time to do whatever we can to help improve the health of others in a time of great need. There are people putting themselves at risk to respond to the COVID-19 epidemic. My hat is off to them, and we need to help them in any way we can.

What lessons do we need to take away from this pandemic?

One message we always want to take is the importance of maintaining public health preparedness. The one side effect of this coronavirus epidemic is people understand the importance of public health and the importance of all segments of society working together to prevent illness and save lives.

This pandemic shows that we need to improve surveillance and international communication. The COVID-19 outbreak is one example of why international relationships and diplomacy are so important. Our relationships between countries and between organizations can be built upon public health preparedness as well as economics and religious or military conflicts. I believe in diplomacy and believe all the countries need to learn to get along with each other and communicate transparently. That may be idealistic, but it’s no more idealistic than an economy built on globalization and trade or upon peace for all.

Video

"COVID-19: State of the Pandemic" (June 2020)