As the COVID-19 outbreak continues to alter life as we know it, Facebook CEO Mark Zuckerberg and his wife Priscilla Chan, who’s a pediatrician, have staged informative virtual discussions with leading infectious disease experts, including Dr. Anthony Fauci, head of the National Institute of Allergies and Infectious Disease.

In an interview with Dr. Don Ganem, the global head of infectious diseases research at the Novartis Institutes for BioMedical Research, on Tuesday, they discussed lessons from past disease outbreaks, the role of testing, coronavirus treatments and the search for a vaccine.

Here are some of the major takeaways from their discussion:

We’ve been here before

The ongoing COVID-19 pandemic and quarantine are often described as “unprecedented.” But even though few of us have seen a nationwide quarantine in our lifetime, this is hardly the first infectious disease outbreak in recent history. 

Ganem noted that in his medical career, he has worked on two epidemics — HIV and the 2009 H1N1 pandemic — and observed others, including SARS and MERS, from afar. And of course, the 1918 flu, popularly known as the Spanish flu, infected a quarter of the world’s population, distinguishing it as the most severe outbreak in modern history.

“This history puts the lie to the statement you often hear: that no one could have seen this coming,” said Ganem.

Pandemics are more common than many may realize, and it was only a matter of time before another major outbreak occurred. This may be the most severe outbreak in a century, but it is not the only one. Furthermore, Ganem noted, the SARS and MERS outbreaks suggested that a strain of coronavirus could easily get out of hand.

And a major coronavirus pandemic was in fact predicted recently. A Johns Hopkins simulation from just last year predicted a global coronavirus outbreak with results shockingly similar to those we’re seeing today. Furthermore, a Kansas University professor who studies coronaviruses gave a lecture last year on the likelihood of a coronavirus pandemic in our lifetime.

History shows us that social distancing works

Across the United States, schools and non-essential businesses are closed and millions are working from home in an effort to reduce the spread of the virus.

Of course, social distancing has widespread economic effects to the tune of millions of jobs and billions, if not trillions, of wealth lost. Concerns over these economic ripple effects have left some questioning the merits of the policy.

However, Granem noted, history shows us why social distancing is worthwhile. During the 1918 flu pandemic, in which over 600,000 people died, cities implemented social distancing measures to varying degrees and saw vastly different results.

Granem specifically mentioned Philadelphia, which staged a World War I parade amidst the pandemic. Some 200,000 onlookers packed themselves onto the streets of Philadelphia to watch the parade, and thousands were infected as a result. Within 72 hours of the parade, the city’s 31 hospitals were overwhelmed.

“Allowing that congregation to happen in the middle of this outbreak resulted in Philadelphia having twice the death rate of St. Louis, which had a very early and widespread and complete shutdown,” said Granem.

“It’s a striking recapitulation of the public debate we’re having now, [in which] business people, tradesman and economists are saying ‘let’s not do it,’ doctors and public health people saying ‘let’s do it,’ mayors going in either direction,” Granem continued. “But the lessons are fairly clear: cities like Pittsburgh and Philadelphia that didn’t do it rigorously, or did it late, or didn’t do it at all, had twice the death rate of cities like St. Louis that did.”

More recent examples also demonstrate the efficacy of social distancing. In 2009, Mexico issued social distancing measures to reduce the spread of H1N1 to great effect. One study found that social distancing and school closures during the first wave of the flu reduced transmission by 29-37 percent.

Expect a resurgence in the fall

According to Granem, we should prepare for a resurgence of the virus during the fall, though we may not have to resort to strong social distancing measures again.

“Let’s be the first to say we don’t know for sure, but the prudent thing would be to count on the idea that there will be a recrudescence, there may well be a recrudescence in the fall — in the late fall,” Granem said. “Why do we think that? Just based on our experience with other respiratory infections.”

Widespread respiratory infections have a tendency to rise during the colder months of the year, when students are in school and people tend to spend more time in close quarters. 

Granem noted that we do not know for a fact that there will be a resurgence of COVID-19. However, given the historical tendencies of respiratory infections, we should expect something of a resurgence later in the year.

There are three types of tests, but only one is widely available at the moment

Throughout the pandemic, we’ve all heard a lot about the importance of testing. Testing allows us to measure the spread of the virus, which will be crucial in determining when society can safely reopen.

But not all tests are created equal. Granem broke down the three types of tests, the testing that is currently available, and how our testing technology is progressing.

• PCR tests

This is the type of testing that is currently being used to measure the virus. PCR tests check for the presence of the virus’s RNA, its genetic information. PCR tests are therefore effective at testing for the virus in people who are infected and have symptoms. They have been useful, to this point, for diagnosis, count and monitoring those who are sick. 

But they also have some drawbacks. The window for viral detection is only a couple of weeks; you can’t measure whether somebody with no symptoms has been exposed, and the test is expensive, sophisticated and difficult to deploy. Furthermore, the test can take a few hours at minimum; it is more time-consuming than alternative testing methods.

• Antibody tests

Antibody tests determine whether someone has been exposed to a virus by detecting the presence of antibodies in the immune system. They are widely used for the detection of a variety of viruses, and are simple, inexpensive and easily deployable.

Antibody tests will be crucial in determining when we can reopen society, because they allow us to gauge whether individuals built up some level of resistance to the virus. They also will allow us to determine how many asymptomatic people have been exposed to the virus. 

However, Granem noted that the presence of antibodies does not guarantee immunity. Some viruses, such as HIV, are adept at fighting antibodies, so we need to identify the COVID-19 antibodies that are protective before we can determine whether an exposed person is likely to become sick if they are re-exposed.

Furthermore, antibodies don’t appear until about 10 days after a person becomes infected with the virus, so they are not effective for determining whether a person that is currently sick has the virus.

Antibody tests are just becoming available now and will be very useful in tracking the spread of the virus. Once the protective antibodies have been identified, they will also allow us to determine who has immunity to the virus and can safely go back into public.

• CRISPR tests

CRISPR is a tool designed and used primarily for genome editing, but it can also be used for diagnostics. Like PCR tests, CRISPR tests detect the presence of the virus’s genome. In theory, CRISPR tests are much faster than PCR and are very sensitive.

However, CRISPR tests are not available as of now. It may take months for them to become widely available. If we were to get them in the relatively near future, said Granem, they would be very practical and useful.

We are working toward finding an effective treatment, but there’s still a ways to go

We are still in the early stages of finding a consistently effective treatment for COVID-19. However, a number of labs are working on researching and developing drugs for the treatment of the disease, including a therapeutics accelerator backed by Bill Gates and funded in part by Zuckerberg and Chan. 

Much of the research currently being done involves testing available medications for efficacy against coronavirus in a lab. Granem noted that these kinds of tests have the advantage of being easy to do on a large scale, meaning you can test a wide variety of drugs at the same time. However, he also noted that this approach is mostly a shot in the dark, hoping that a drug designed for a different purpose happens to be effective against COVID-19. Furthermore, even drugs that perform well against the virus in a lab setting may not be effective in human bodies.

However, Granem noted that the possibility of finding a drug that can be either repurposed or used to develop a drug for coronavirus treatment is worth the shot.

“That’s a shot on goal you just absolutely have to take,” he said. “You can’t not do something like this. I’m a hockey fan and as Wayne Gretzky said, you’re not going to score on a shot you don’t take. I just think you have to be realistic about not pinning all of your hopes on that.”

Hydroxychloroquine and azithromycin show promise, but we need to know more

You may have heard about the potential merits of hydroxychloroquine, a drug typically used to treat malaria, and azithromycin, an antibiotic, as a treatment for the novel coronavirus.

Hydroxychloroquine, a derivative of chloroquine, in particular has made headlines due to President Trump’s advocacy for its use.

“It’s an open question whether [chloroquine] could be a good antiviral or not,” Granem said. “There’s a reasonable scientific basis for trying hydroxychloroquine in this infection. But let’s be honest, chloroquine is also active against dengue in culture, it’s also active against Chikungunya in culture, and the clinical trials of both of those diseases were unsuccessful.”

In other words, these drugs are worthwhile to investigate as treatments for the novel coronavirus, but there is no guarantee as of yet that they will be effective.

More testing is necessary to prove the drug’s effectiveness. Clinical trials for both chloroquine and hydroxychloroquine are underway. 

We need to mobilize to create a vaccine

Most experts estimate that we are still between 12 to 14 months away from the development of a vaccine, and we will need to take a variety of approaches in order to get there within that timeline.

A year from now may sound like a long time away given the severity of the COVID-19 outbreak at the present moment. However, vaccines generally take a minimum of 5-10 years to develop. 

Granem said we will need to take a broad-based approach in which we explore all of the available methods for vaccine development at once. There are various different types of vaccines, such as protein-based vaccines or inactivated vaccines. Any of these approaches may work, but, Granem noted, we don’t have time to make any assumptions.

“Given the urgency of this situation, the government and industry should be pursuing all of these lanes simultaneously,” he said. “We don’t have time to make guesses in advance of what’s going to be the optimal approach.”

Conclusion

The coronavirus outbreak often feels unfamiliar and frightening. After all, we are facing the most severe global health crisis in recent memory. However, we are in a strong position to beat the virus and rebound economically. But in order to do that, we have to take aggressive action to social distance, expand testing, identify and deploy treatments, and develop a vaccine.