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With testing still limited, coronavirus remains a ‘moving target’

By Kara Manke | March 17 2020

A worker from a Servpro disaster recovery team wearing a protective suit and respirator peers out a window as he waits to exit the Life Care Center in Kirkland, Wash. for a break cleaning the facility. The nursing home is the center of the coronavirus outbreak in Washington state. (AP photo by Ted S. Warren)

When Berkeley News first spoke to medical doctor and infectious disease specialist John Swartzberg in early February, the United States was home to only a handful of cases of the new coronavirus infection COVID-19, and many were optimistic that travel restrictions and quarantines on affected individuals could quickly contain the virus.

A little more than a month later, the number of confirmed COVID-19 cases in the United States now tops 3,400, and with testing still limited in many regions, the actual number of people carrying the virus could be much higher. Efforts to prevent transmission of the highly contagious disease have upended lives across the nation, with schools shutting down, bars and restaurants closing, large events cancelled and many required to work from home or losing their jobs altogether. And, at midnight on Tuesday, March 17, residents of six Bay Area counties were ordered to shelter in place, limiting any non-essential travel outside the home.

In a new interview, Swartzberg underscores the fact that  in part due to poor leadership by the executive branch of our government, the Centers for Disease Control (CDC) and the Food and Drug Administration (FDA), which failed to deliver adequate testing on time  we still don’t have enough data on the virus to really know how widespread the disease will ultimately become, or how long these drastic social distancing measures will last. But, he says, preventing transmission through hygiene and limited social contact remain crucial to avoid overloading our hospital system.


 Faculty Headshot for John Swartzberg

John Swartzberg is clinical professor emeritus of infectious diseases and vaccinology in the the UC Berkeley-UCSF Joint Medical Program.

Berkeley News: What is currently known about the disease progression of the virus? What symptoms should people watch out for?

约翰swartzberg:因为这个病看起来非常相似,流感,甚至是非常老道临床医生不能使通过个人的病史和体格检查的区别。患有这种疾病,并与流感,人们会通常会得到全身酸痛,发热显著和咳嗽。人们应该看出来的,无论事业的事情,是如果他们开始感到呼吸急促。这是一个呼吁立即得到一些医疗照顾。

If you’ve got symptoms consistent with either influenza, or COVID-19, or another respiratory pathogen, that’s a reason to call your doctor’s office and ask his or her advice about what you should do. They may want to do a rapid influenza test, because there’s a drug to treat influenza. If the influenza test is negative, that may prompt the test for COVID-19.

How do we make sense of the reports about the mortality rate of COVID-19, which seem to range from 1% to 3.4% and even as high as 6% in Lombardy, Italy?

是的,病死率是一个困难的数目来计算。其中的原因是,它的是谁死在谁是在规定的时间内感染者人数人民病例数的比率。我们不知道有多少人被感染。已公布的数字是人感染,因为我们没有做足够的测试数量的轻描淡写。如果感染者人数的增长,死亡率就会下降。

On the other hand, if you look at how you calculate the fatality rate, you’re looking at the number of people who died at a particular time over the number of people diagnosed with the disease at that same time. But the number of people who died doesn’t include people who are sick, who in the next week or two might die. If that’s the case, then the case fatality rate may actually be higher that what we measured.

Better testing will give us a better handle on it, but for now, it’s a moving target. All of that said, here in the United States, the Johns Hopkins site, for example, suggests that the case fatality rate is about 3.4%

Angela Merkel said that up to 70% of Germans will eventually contract COVID-19. In a panel last Tuesday, UCSF doctors said the same thing: We can expect 50% to 70% of Americans to get COVID-19 this year and up to 1.6 million to die from it. Are these worst-case scenarios or the likely scenario?

这些都是基于我们所知道的病毒和它在人类群体行为的所有模拟研究。该模型只是不如资料,他们拿到了,我们一直在谈论如何限制数据。因此,该造型是在试图了解发生了什么事情有帮助的,但我认为,我们来看看它的一些程度的怀疑。所以,也没有必要担心有关数据,但我当然不会,从规划的角度来看,无论是忽略它们。

Why has been so hard to get the number of tests that we need? Is it particularly hard test to develop?

The technology to do this testing has been around for 35 years. It’s very easy to do, and all laboratories can do it. It’s done many times a day here on our campus. So, it’s not the technology that was the limiting feature. The blame goes squarely on the CDC and the FDA, and certainly to the executive branch of our government.

I’ve not been privy to any of the discussions at the CDC and the FDA. That said, just like the public has been getting very mixed messages from the current administration, the FDA and the CDC have also received mixed messages that have created a great deal of confusion, in terms of how to conduct things.

Very quickly, the Chinese researchers identified the entire viral genome and made it available worldwide. The Germans developed a test based upon the data from China, they gave it to the WHO, the WHO disseminated it to all the countries and the United States said, “No, we’re going to develop our own.” Why? I have no idea. I think it’s an element of bureaucracy, and it’s an element of hubris.

疾控中心终于运到国家卫生部门少数测试在二月初,和广大那些有缺陷的引物,这意味着他们没有工作。所以,他们立即撤回或召回了所有这些测试。花了三年半周疾病预防控制中心发送新信息以及更正的测试。为什么花了三个半星期的技术,是35岁的,我不知道。但这些都是一些问题的答案:政治,官僚主义,傲慢,自大,无能。

I see a lot of people stressing the importance of “flattening the curve,” or slowing disease transmission, through social distancing and hygiene measures. Could you explain a little about what this means and why it is important?

顺便保健交付今天比40年前甚至20年前截然不同。今天,医院非常高效地运行。什么效率转换到,部分地是,他们没有很多的设备的商店。他们没有很多额外的床,因为加床的效率不高。所以,我们有显著少一些美国的医院,一般和显著较少数量的病床和较少数量的ICU病床的比我们20年前。所以,如果发生流感大流行,它不是建来处理。它具有非常小的间隙。

我们必须设法限制我们的卫生资源的利用率,使他们将在那里为大家谁生病。你是怎样做的?而不必在情况下,大穗,然后下降的,我们尝试,正如你说的,扁平化的曲线。我们尽量减少病毒的传播,因此,即使受感染相同数量的人最终结束了,而不是在时间的六个或八个星期内发生的一切,它在3至6时 - 月,甚至12个月的时间。如果我们能够扁平化这条曲线,这将意味着,我们应该有足够的病床,我们应该有足够的人呼吸机。但如果我们不压扁这条曲线,我们会在同一个地方,意大利是现在,使得谁在呼吸机去谁死的选择。

Many policymakers and public health experts are urging social distancing through working remotely, canceling large events, and now, in the Bay Area, issuing a shelter-in-place order that limits all non-essential travel outside the home. Do you know how long these social distancing measures are likely to last?

这是一个水晶球问题。没有人知道答案。我们人类从来没有遇到过的病毒。这意味着,我们有近100%的人口受到这种病毒的。所以,有很多人认为该病毒可以继续感染。我们不知道,如果我们到了病毒后,我们从感染中恢复免疫力给了我们永久免疫力与否。如果是这样,那么病毒,最终,因为它传播如此之快,会烧坏,因为它不会有足够的主机。这就是所谓的群体免疫。但另一方面,如果我们的免疫力不是永久性的,如果它在几个月减弱,那么感染可能继续闷烧年。我们没有回答这个问题。

Based on your experience and scientific understanding, what do you think the next few months are going to look like? What should we expect, as individuals and as a larger society?

我认为我们已经有了这方面的一个味道。三个星期前,我从来没有想到,我们不会看到疯狂三月或有NBA取消其比赛。我不会相信我们会看到所有的这些学校关闭。所以,我们不得不非常根本上改变我们这个世界的看法在很短的时间跨度。我们都不得不蹲下下来。我们正在做远程教育和远程工作。我认为我们将继续看到我们的生活仍然显著改变。当我看着我的水晶球,我的猜测是我们在这数月,甚至更长的时间。我希望我是错的。


This article originally appeared on the Berkeley News Website.