Is the U.S. healthcare system prepared for the coronavirus crisis?

March 03, 2020

While new confirmed cases are dropping in China, the novel coronavirus continues its spread on a global scale with cases surging in countries such as South Korea, Italy and Iran. Will the coronavirus cases of unknown origin happen again in the U.S.? How prepared is the U.S. healthcare system? What can U.S. learn from China’s experience in handling the coronavirus? In what ways can technology help fight new diseases?

On Tuesday, Jeffrey Shaman, Professor of Environmental Health Sciences at Columbia University Mailman School of Public Health, joined China Global Television Network “Dialogue” to discuss these issues and more. Watch the interview below.

The following is an edited transcript of the interview between Professor Shaman and anchor ZOU Yue.

Q: The WTO has just wrapped up its investigation here in China and their conclusion is that the disease can be contained and China's responses to the outbreak have yet a notable result. What do you think of the WHO’s assessment?

Shaman: I think what the Chinese government and people have accomplished in curtailing the virus is really remarkable. We haven't seen that kind of reduction in a respiratory virus transmission event like this ever. I'm not as optimistic as the WHO because the virus is spreading very aggressively in South Korea, Iran, and Italy, and I believe it will be spreading in many other countries similarly. Once China has to return to normal economic activity, the virus is going to be reintroduced. That's a big problem.

Q: So you're saying that the temporary decline of infection growth may not remain?

Shaman: Yeah. The question is how long you can keep these measures in place that are effectively curtailing the transmission. It appears that much of the transmission is supported by undocumented cases – in other words, infections that are of milder symptoms who are not seeking clinical care. In other countries, these are the people who are probably facilitating the aggressive spread, and that’s what probably allowed the virus to spread so quickly in China. The question you have to ask is what is the endgame of the types of measures that have been put in place within China? They can forestall the outbreak, but ultimately they are holding out for the development of more advanced and better therapeutics or vaccine because the virus will return once international trade and commerce return to China.

Q: But the Chinese experience is saying that we keep people at home for self-isolation, waiting out the incubation period. When there are symptoms, they will go to hospitals for care. Why that experience can’t be copied elsewhere?

Shaman: The thing is how well you can actually enforce the compliance of that. But the virus has already spread to dozens of other countries. As it spreads worldwide, the question is if every country is going to have the wherewithal and the means to actually enforce that kind of containment, particularly in the developing world.

Q: Could you please explain why it took the virus only a month to travel all the continents in the world, probably except Antarctica? Does it mean the virus is very contagious or people are underprepared?

Shaman: Again I think it's because of the undocumented cases. If the majority of people who are infected are only suffering mild symptoms, they don't stop traveling. They don't stop going to work and going to school. As a consequence, they're going to get on airplanes, they're going to get on trains, and they're going to travel long distances with the virus. If they are contagious while they are not manifesting many symptoms, it is particularly problematic. Now we have seen this in our own active sampling here in New York City with other seasonal coronaviruses. There are two ends of the spectrum. In SARS, which emerged in the late 90s, almost all infections were symptomatic and documented. The ascertainment rate was very high. In other seasonal flu, the ascertainment rate was very low. These seasonal coronaviruses spread very efficiently because most people just continue their business while they have a little bit of a sniffle.

Q: This isn't a very typical coronavirus. It's more like a flu virus?

Shaman: Absolutely. It is behaving more like flu. In a bad flu, there maybe one in five people seeking medical treatment. A lot of other people are going to have milder symptoms and to be contagious. They facilitate the transmission of the virus.

Q: The problem is the mortality rate of this virus is much higher than that of a bad flu. So it's more like a flu that will be a lot of casualties?

Shaman: Right. So you have to look at historic flu pandemics to get some bearings on it. The 2009 pandemic had a mild fatality rate. The other end is 1918 that had about a 2.5% fatality rate, but it probably had a lower rate of asymptomatic infection. The novel coronavirus has a higher rate of asymptomatic infection or about the same fatality rate. Therefore, we're looking at an upper bound of about 10 to 11 million people potentially dying over the next two years. Fifty percent of the world's population is infected within two years, which is a rule of thumb. But there are a lot of things over the span of two years that can happen to change that. We can improve our therapeutics. We can develop a vaccine. Those are the critical things that are going to be needed.

Q: I understand there was a new reported case in California where people don't know why he got infected. How are you worried about the spread of the disease in America?

Shaman: I certainly am worried about it. I don't think there's a portion of the world that can exempt from having to contain this virus. It is just a matter of time that the case reported in California to be reported. The question is how quickly will the virus spread through the U.S.? What kind of measures will we be able to control it? Can we do something as successful as China? How well are we going to be able to deliver care to many people who are probably coming to hospitals as our system is overwhelmed? Do we have to adapt some of the practices in the emergency medical responses?