The U.S. passed a tragic milestone this week, becoming the first country in the world to record 100,000 deaths from Covid-19. Is there an end in sight? Is this the new normal? Yale epidemiologist Gregg Gonsalves joins Mehdi Hasan to discuss where we go from here.
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Gregg Gonsalves: It’s a catastrophe. It’s death by public policy. It’s premeditated. They know what they’re doing. You should feel it as a national catastrophe, and a global outrage.
MH: Welcome to Deconstructed. I’m Mehdi Hasan.
It’s official: This week, the death toll from Covid-19 in the United States crossed the 100,000 mark.
GG: It’s slightly under the population of New Haven, Connecticut, so think about wiping out the city I live in, right now, over the course of 3 months.
That’s my guest today, Yale University epidemiologist Gregg Gonsalves.
So what happens now? What does the science say? And can this virus be beaten, by us, acting as individuals, as communities, even with an incompetent leader like Donald J. Trump in the White House?
Newscaster: The nation stares down a grim milestone.
Newscaster: 100,000 deaths from the coronavirus. It is a staggering number, reached at a shocking pace.
Newscaster: The U.S. has more cases and deaths than any other country.
MH: By the time you listen to this podcast, the official death toll from Covid-19 in the United States will have crossed the 100,000 mark. That’s 100,000 people dead from Covid-19 in the U.S. — the highest number of deaths in the world. Men, women, children, Holocaust survivors, World War II veterans, playwrights, actors, teachers, janitors, doctors, nurses, kindergarteners — all gone, in the space of just four months.
That’s more Americans than died in the Korean, Vietnam, Persian Gulf, Afghanistan, and Iraq Wars.
That’s more people than die every year in the U.S. from drug overdoses, gun violence, HIV/AIDS.
100,000 dead people — many of whose blood is on Donald Trump’s tiny hands.
And that’s not hyperbole; that’s not just me just gratuitously or personally attacking the president because I don’t like him. No, that’s what actual scientific studies suggest: last week, researchers at Columbia University found that if the United States had begun imposing social distancing measures one week earlier than it did in March, just one week earlier, around 36,000 fewer people would have died — 36,000 fewer people. Two weeks earlier, and there’d have been 54,000 fewer deaths from the coronavirus in the U.S. — 54,000 people.
Trump’s response to that damning study?
President Donald J. Trump: Columbia is a liberal, disgraceful institution to write that.
MH: Yeah, science, mathematics, epidemiology — they all have a liberal bias, apparently. Facts are biased against conservatives; they can be safely dismissed if you’re on the Right. Remember when conservatives used to go on about ‘facts don’t care about your feelings’? Well apparently if the feelings of the thin-skinned orange dude in the Oval Office are offended then, no, actually, facts should be ignored; science should be disregarded. How convenient.
Never forget, though, that the death toll — now officially above 100,000, was supposed to be zero. Zero! That’s what Trump himself said at the end of February:
DJT: When you have 15 people, and the 15 within a couple of days is going to be down to close to zero, that’s a pretty good job we’ve done.
MH: Close to zero? So he was only off by 100,000 deaths and 1.6 million cases.
Yet, the really big problem is that we don’t seem to care that much anymore, not like we did at the start of this crisis; perhaps it’s pandemic fatigue, perhaps it’s that old line misattributed to Stalin: ‘One death is a tragedy, a million is a statistic.’ But even those of us who loathe Trump have become numb to the mounting death toll. It’s become a kind of background noise on our social media feeds.
But it shouldn’t be. These are not just numbers — these are people, with lives, legacies, families. And they’re gone. Americans should be mad. Angry. Fricking furious. The vast majority of these deaths, in the richest country in the history of the world, did not have to happen; they were preventable. Be mad about that. Don’t let the people in power get away with it. South Korea had its first case of Covid-19 on the same day as the United States back in January; today South Korea has lost less than 300 people to the virus. The U.S. has lost more than 100,000.
But, but, we have — and I think this was always Trump’s aim, his goal — normalized this horrific and record U.S. death toll, normalized mass death, made it a price worth paying for the “re-opening” of the economy. The pro-life party, so-called, is now the pro-death party. And we just accept that. Just like we’ve accepted every other broken norm, and violated law, and abuse of power, and major scandal that we’ve witnessed, in plain sight, over the past three and a half years. Just like we’ve uniquely, among the world’s industrialized countries, accepted gun deaths in this country, in the tens of thousands, for far too long!
I guess the fact that the victims of Covid-19 are disproportionately black and brown helps people to ignore it, minimize it, normalize it. I mean, this is how Alex Azar, Trump’s health secretary, defended the record number of deaths from Covid-19 in the U.S., on CNN recently:
Alex Azar: Unfortunately, the American population is very diverse, and it is a — it is a population with significant unhealthy comorbidities that do make many individuals in our communities, in particular African-American minority communities, particularly at risk here.
MH: Got that? It’s the diversity that’s causing the mass deaths! Those irresponsible, unhealthy black people!
Meanwhile, as one white member of the public who was out and about in a wealthy suburb of Georgia, as he told the Washington Post recently: “When you start seeing where the cases are coming from and the demographics — I’m not worried.”
There you have it: Saying the quiet part loud. It’s those poor black folks who are dying, not us, so why should we sacrifice our haircuts and our trips to the nail salon?
By the way, it’s worth pointing out that while, yes, black and brown people are disproportionately suffering from Covid-19, the majority of deaths still are of white people and, as the Post reported last weekend: “Rural counties now have some of the highest rates of Covid-19 cases and deaths in the country, topping even the hardest-hit New York City boroughs and signaling a new phase of the pandemic.”
A new phase — it’s not going away anytime soon. You can expect new waves of the virus, especially as we drop our guard, we relax our social distancing, as states ‘re-open’ for business.
And yet the federal government has no plan. Donald Trump is busy trying to force the state government in North Carolina to let him hold a packed GOP convention there, in August, in defiance of all social distancing rules — more crowds, more deaths.
But then again, why wouldn’t he try and do that? Why wouldn’t he try and get away with this all? Remember what then-candidate Trump said in January 2016:
DJT: They say I have the most loyal people. Did you ever see that? Where I could stand in the middle of Fifth Avenue and shoot somebody, and I wouldn’t lose any voters. OK? It’s like, incredible.
MH: It turns out that Trump didn’t have to kill a man in the middle of Fifth Avenue, New York, to prove how loyal his followers are — over the past 4 months he’s helped the coronavirus kill 100,000 people across this entire country and yet his approval rating with Republican voters is still around 90 percent. He still has more than 40 percent support, almost half the country, among the public at large: 100,000 dead hasn’t dented that.
And so here’s the big challenge: Trump will be president for at least the next 8 months, if not longer. Can this virus be beaten with him in charge? How many more deaths are coming on his watch — and are we ready for the almost-inevitable second wave of this horrible pandemic?
MH: My guest today is an Assistant Professor of Epidemiology at the Yale School of Public Health and Co-Director of the Global Health Justice Partnership. As a young man in the 1980s, Gregg Gonsalves was also a prominent activist with the AIDS-advocacy group ACT UP.
Gregg recently made headlines when he pointed to the number of black and brown deaths from Covid-19 and suggested the Trump administration was getting “awfully close to genocide by default.” Strong words.
He joins me now from New Haven, Connecticut, to offer his insights and his expertise.
Gregg, thank you for coming on Deconstructed.
GG: Thank you for having me.
MH: Gregg, if I say to you: 100,000 people dead from the coronavirus in the United States, what’s your first response? What do you think?
GG: It’s a catastrophe, right? Um, you know, if we start to try to add up those figures, it’s — the death toll of, that happened in the Vietnam and Korean War combined, in the United States. It’s three times the population of my small hometown in New York. It’s slightly under the population of the town that I’m sitting in right now, New Haven, Connecticut. So think about wiping out the city I live in right now over the course of three months, and you should feel it as a national catastrophe, a global outrage.
MH: And do you agree with data scientists at Columbia University who say that tens of thousands of deaths could have been prevented if the government, both the federal government under Donald Trump, and state government in places like New York and Andrew Cuomo, had they acted earlier?
GG: Well, you know, nobody can sort of go back in time and, and understand what would have been. But I do think we have some counterfactuals in the response to the pandemic by places like New Zealand, like South Korea, Hong Kong —
GG: — Germany, Denmark. And so yes, I think there are tens of thousands of deaths that were avoidable if we had acted earlier. What’s important to note is that there’s still no national response in the United States, so we’re still in sort of this head in the sand mode in terms of how we’re dealing with the pandemic. And so there’ll be lots of other avoidable deaths with the months and years ahead.
MH: How high do you think the death toll will go, given, as you say, there’s still no plan, even now, several months into this crisis, we talk about ‘reopening,’ but there’s no actual plan to beat this virus from the federal government. So how many more deaths could we expect?
GG: Well, you know, again, it’s hard to predict the future. But it’s pretty clear that — the Imperial College of Medicine in the UK just came out with a report on Sunday that suggested about 24 — so slightly under half the states in the United States — have uncontrolled epidemics, right? Which means we are not “flattening the curve” as a nation in terms of deaths anytime soon.
While the big caseloads in New York City and in Boston may be ebbing, we’re seeing new cases and new hotspots appear in the South and in the Midwest. So I think we’re gonna see a plateauing of deaths, maybe a slow decline during the summer and maybe resurgence in the fall, but the point is, is that there’s no way that we should expect the epidemic to be under control in the United States, because we haven’t made the effort to make it that way.
MH: You’ve said that given the high proportion of deaths among African Americans and Latinos, “This is getting awfully close to genocide by default. What else do you call mass death by public policy?” Do you think accusing Trump of genocide is hyperbole? Or would you stand by that description?
GG: So you know, today a comrade of mine, Larry Kramer, who is the founder of ACT UP, died in his apartment in New York at 84 years old. And back in the 1980s we were all going to funerals every week, every month, and hundreds of our friends were dying week after week after week.
It took 10 years for a 100,000 to die of AIDS in this, in this country and it took seven years for the president then to sort of speak out, and even say the word AIDS. We’ve done this in, in three or four months we’ve lost 100,000 people across the country — again, many of them people of color, Latinos, African Americans.
And no, it’s not akin to the Nazi genocide or the Rwandan genocide, but it’s death by public policy. You may think it’s a trivial example, but Elizabeth Taylor, the, the former Oscar winner, once at an AIDS conference said that what had happened in the AIDS epidemic was, was akin to premeditated murder — maybe that’s an apt, better-apt phrase. It’s death by public policy. It’s premeditated. They know what they’re doing.
There’s too many people who said, from both sides of the aisle, from the center-Right and the center-Left who have said, you know, you need to take a concerted effort to test, trace, isolate, and they’ve been saying it for months, and the White House has said, “You’re on your own. Tough luck. It’s not my responsibility, I take no responsibility.” So, yeah —
GG: So maybe using the word genocide was hyperbole,
MH: But he’s complicit in deaths, is what you’re saying, in mass deaths. Do you think Trump could be held liable one day for the deaths on his watch? Glenn Kirschner, who’s a former federal prosecutor, said on this show a few weeks ago that he believes U.S. states could bring charges against Trump for manslaughter as soon as he leaves office in January 2021, assuming he loses.
GG: So, again, I’m not a lawyer. I don’t know the criminal law. I don’t know the law of war crimes, for instance. And so, you know, I think he needs to be held politically responsible. I mean, what I’m thinking is that we should have a 9/11-like commission or Truth and Reconciliation Commission, as soon as we can sort of mobilize ourselves to do it, because I think there’s also the trap of thinking it’s just about Trump, right?
It’s not just about Trump; it’s about Mitch McConnell in the Senate. You know, what happened in New York City also needs some scrutiny.
GG: There was some sort of a weird tangle of delay between the governor and the mayor of New York City, the head of the Health and Hospitals Corporation in New York City, and the head of the Health Department, all sort of striving for position and control over the early epidemic, which again probably led to more than a few hundred unnecessary deaths.
MH: Let’s talk about the virus itself and how we fight it, how we protect ourselves against it. I want to take advantage of your expertise, and put some questions to you that a lot of us have — a lot of friends and family members and colleagues of mine, we discuss this endlessly, as I’m sure many of our listeners do. And everyone has an opinion. Nowadays, everyone pretends to be an expert on stuff like this.
You’re an actual expert. Let me put some questions to you: We know Trump’s criteria for ‘reopening’ are self-serving, unscientific BS, but what are the actual scientific criteria you would use to say we’re ready to go back to the way things were, we’re ready to open states and go back to school and go back to work? And how far away are we from meeting those criteria?
GG: So one is that Trump’s own scientific advisors have laid out a plan for moving ahead, which is somewhat in sync with sort of the outside advice that people like Scott Gottlieb, who is his former FDA Commissioner, Tom Frieden, who is a former CDC Commissioner under President Obama, and others have laid out — is that we need to see sustained reduction in cases, hospitalizations, over two weeks or more. And that’s not like just a slight decline in cases, it’s a real substantial decline.
Then we’re going to have to have testing scaled up to a degree that we can understand what the shape of our epidemic is out in the communities that we’re going to start to unleash people in, right? And then we need to figure out who’s infected, need to trace their contacts and isolate them in a humane way to take care of their social and economic needs. There and then we can move ahead to start to reopen our states. But, you know, the cow is out of the barn or whatever the phrase is, here in the U.S., is that, you know, most states have not met these criteria by a longshot.
MH: And yet they’re plowing ahead, regardless. How worried are you about a second wave? Is it inevitable?
GG: You know, I’m, I’m not going to play fortune teller, but all the the preconditions for a second wave are in place: relaxing the social distancing in the middle of uncontrolled epidemics, as the Imperial College report showed on Sunday, the, the sort of still paucity of testing around the U.S., the sort of really fitful starts to contact tracing around the, around the country.
So, you know, if you look at countries — China, South Korea, look at Hong Kong, look at Germany, look at Denmark — all these other countries have figured out how to scale up their public health response to deal with the first part of the crisis, which was the first wave, and are ready for the second wave. We still are sort of spinning our wheels in terms of, sort of, the initial response.
GG: And sort of, probably about three or four weeks ago, we threw up our hands saying: You know, we can’t do it. We’re just gonna open up and come what may. I mean, even here in Connecticut, I think we’re the last state to reopen. There’s, I don’t think there’s any sort of graduated plan of reopening, I think it’s slowly, by the middle of the summer, most of the restrictions will be lifted. And we’ll be, it’ll be up to you and me and other people alone to sort of decide if we’re going to shelter-in-place. And I think that’s going to be done based on, on, on our ability to do that.
MH: So let’s talk about our ability to do that, and in terms of what you and I can do, and ordinary people can do. In terms of social distancing, this phrase that we — none of us had heard of a few months ago, but we now all talk about it endlessly — social distancing when you’re out and about, what is the safe way of doing it? Is it three feet, six feet? Is it six feet plus a mask? Is it 27 feet? Because I know there’s been studies showing that to be safe from coughing or sneezing or loud talkers, it’s better to be 27 feet away. What is the best way, in your view, to socially distance when you have to go out and walk around and be in public?
GG: There’s a spectrum of ways to keep yourself safe. Julia Marcus, a friend of mine who’s an epidemiologist in Boston, said in a piece for the Atlantic and Vox, the news site, put together a sort of infographic on it about sort of harm reduction in the context of social distancing.
So the safest thing to do is what you and I are doing right now, we’re talking on the phone, sort of sheltering in place, doing our business in our apartments. When we go out, we should be wearing masks, right? Particularly if we’re going to be going to a grocery store or other sort of places where there are other people. When we’re talking to people on the street, we should maintain six feet of distance, wearing a mask as well.
So what Julia Marcus has said is that, you know, you need to think of it on a continuum, from lowest risk, to medium risk, to higher risk, to highest risk, right? Highest risk is being unmasked with other people in a closed environment. So think a crowded bar, on a Friday night, without masks.
GG: Or a restaurant on a Saturday evening, again without masks, at full capacity.
GG: And so we’re trying to reduce our risk, you know? We can’t sort of bubble wrap ourselves and protect ourselves completely and keep our sanity, right? We want to be able to sort of figure out how we can do this for the long term.
MH: Should schools, in your view, be reopening in the fall? Because some of us who are parents of young kids, we’re wondering, do we send our kids back to school? The scientific evidence is mixed. Some people say there’s a low risk of transmission from kids. Others, including Dr. Anthony Fauci, say, we don’t know enough about the risk, we need to be more cautious.
In Germany, they’re slowly opening up their schools. In Switzerland, I believe they’re allowing under-tens to hug their grandparents, because they say there’s such a miniscule risk of transmission, they believe, from those kids. Where do you stand on this?
GG: Well, I think I would agree with Dr. Fauci that we, it’s not even six months that we’ve sort of been living with this virus, right? Yes, you know, the first cases were at the end of 2019, beginning of 2020. But, you know, it’s not even June yet, we don’t even have six months of information on how this virus reacts in these, in these settings. We shut everything down. And now we have to figure out how to open it up safely.
I think when you’re thinking about places like universities, I think you’re thinking about how you’re going to test everybody; you need to know what your, the state of your epidemic is within your institution. And that’s going to mean testing not once when they come back in the fall, but doing it on a regular basis. The other thing is that, you know, if we’re talking about young schoolchildren who may be at less risk of serious disease, they still may transmit the virus but, you know, children don’t go to school alone. They go into schools with, with, with their teachers, with their administrators, with the people serving them lunch in the cafeteria.
MH: Good point.
GG: There’s a whole set of risks that’s not about them.
And the other, the other piece here is that if we think of schools, or prisons, or nursing homes, or meatpacking plants as institutional amplifiers, it’s not just about what happens in that school and happens to those kids, but it’s what goes into these amplifiers and comes out into the community at large. And you could use, these things could propagate larger epidemics.
MH: We’ve talked a bit about going outdoors, whether it’s going out to the grocery store or being on a university campus. There’s another issue, of course, with this virus, which is even at home people are worried about how they’re getting exposed, though, because people have to buy groceries, they get deliveries from Amazon or wherever it is. They bring home their, you know, food and groceries to the house and unpack it.
You have this New England Journal of Medicine study in March showing that the virus is still detectable up to three hours in the air, I believe, up to four hours on copper, 24 hours on cardboard, two to three days they said on plastic, or stainless steel. The CDC recently revised its guidance and said actually, surface transmission is very low risk, not really that much to worry about. A lot of people don’t know whether they can trust the CDC anymore, given how many mistakes they’ve made since this crisis began. Should we be taking the guidance on surfaces seriously, not seriously, where do you stand on that?
GG: So again, you know, we are not going to bubble-wrap ourselves and dip ourselves in disinfectant every time we go out of the house. The point is, is that you know, if I go to the grocery store, I’m wearing a mask, I’m wearing disposable gloves. And, you know, they have disinfecting wipes at the store, and I wipe down the surface of the cart that I’m using in the grocery store.
The point is you use all reasonable precautions. The idea is not to sort of keep you so afraid that you never leave your house or you can’t do it without sort of this state of high anxiety. The point is wash your hands, you know, wash them for 20 seconds, two rounds of happy birthday, or however you want to count it. Wear gloves in, in public settings where you’re going to be touching surfaces, wear a mask, and you know, those basic precautions are going to do a lot.
If we all wore masks, if we all wore gloves when we needed to be in places that are high-touch environments, like stores, if we used you know, we washed our hands when we came home, we’d do a lot of good, in addition to sort of the social distancing that we’ve been doing for many, many weeks,
MH: But isn’t the problem that you get this kind of mixed advice. So you have the CDC saying it’s not a risk on surfaces, you have other scientists saying it could be a risk, people don’t know what to believe.
GG: eah, and look, you know, this is in the context of the president saying take hydroxychloroquine, and I’m not usually gonna wear a mask because I’m the president of the United States. So like, it’s not even poor messaging, it’s the misinformation, disinformation that’s come out of the White House since the beginning, which is the biggest problem, right?
GG: In general, I am inclined to believe the CDC guidance. I’ve looked at it. It’s not, you know, I think details about whether there’s going to be transmission from a copper surface versus a wood surface — again, we’re like, we’re four-to-five months into this. None of these experiments have been done. We’re extrapolating from, from, sort of, other diseases, other situations. But what, what the CDC is recommending and what other public health bodies around the world are recommending are sort of the basic public health protections that we’ve used for decades now to sort of deal with sort of respiratory viruses.
And this isn’t, you know, the big thing is Covid-19 is not some new virus from outer space. It’s the Coronavirus. There are coronaviruses in our daily lives, common cold, SARS, MERS, and you know, we’ve had some exposure to think about how to deal with them, and so we don’t have to, sort of, get too obsessed about every little detail about trying to protect ourselves.
MH: And you mentioned the importance of testing. And, of course, the U.S. isn’t testing enough. But again, then there’s a question mark about the test results, and how much can they be trusted. There’s all these studies now coming out suggesting, NBC News had a story this week about how the Covid-19 test, something like 20 percent of results are false negatives, are missing the disease, even the antibody tests, according to the CDC, are wrong 50 percent of the time. How much faith can be placed in a testing apparatus if they’re missing so much of the disease?
GG: So we make a lot of judgments in our lives with partial information, right? Every day, every day we walk out of the house making decisions that we don’t know everything about what’s going to happen. And the point is, is not to sort of wrap yourself in this notion of some paranoid hysteria that nothing is true, nothing is certain — it’s like, I deal with risk every time I wake up and get out of bed. And so yes, we don’t know all the details about how the virus gets transmitted on surfaces. But we do know that if you wash your hands, and you wear gloves, and you wear a mask, and you don’t touch your face, that’s a good thing.
You know, the question about six feet or 20 feet or whatever, we know that it’s not under six feet, right? You know, the question about the tests: yes, there are some false negatives with the tests. But you know, if I had respiratory symptoms, and a fever, and other symptoms of Covid, and I got tested and had a negative test, I’d probably assume I had Covid.
MH: But that doesn’t help the asymptomatic folks, though, does it?
GG: No, it doesn’t. And, and, you know, the tests are gonna have to get better. You know, in HIV, what we do is we screen people for disease and then we give them a confirmatory test. You know, maybe there’s a question of how we’re going to sort of change our testing algorithms or develop better tests to get us through. The point isn’t that we do have diagnostics that are pretty good. Are they perfect? No, but most tests are not 100 percent sensitive and specific.
MH: By the way, just on the whole antibody test and testing whether you may or may not have had it already. Is there any clear evidence on whether you can catch the virus again, having already had it? Whether having it beforehand gives you immunity?
GG: Well, a couple of things. One is that I don’t think there’s been any sort of well-documented cases of reinfection. I think what we’re talking about in terms of immunity is that, you know, you develop antibodies to infections as your body encounters them. Do those antibodies confer immunity to an infection or not? And how long do those antibodies last and how long does protection, the protection last?
Some coronaviruses, like the ones that are associated with the common cold, you know, wane after a few months, a year and, and you’re, you’re susceptible to the same kind of virus. It looks like SARS, maybe two-to-three-years protection or more. We just, we simply don’t have the, the timescale right now to understand how long antibodies to SARS-CoV-2 might be protected, if they’re protective at all. We’re just going to need to figure this out as we go along. But saying that because I took an antibody test and I was positive makes me immune is not a risk that I would want to take right now.
MH: And a lot of scientists, as you know, at the beginning of the crisis, especially in my home country, the UK, and elsewhere in Sweden, and elsewhere, talked a lot about herd immunity. In fact, one of de Blasio’s main health advisors was talking about it in private emails, as we now know. Is that still an option? Or is that been thoroughly discredited, the idea of herd immunity?
GG: Well, you know, the Swedish example didn’t work out too well. They have some of the worst death rates in Europe now, and they didn’t avoid the economic consequences of what happened —
GG: — around the rest of the continent. To reach herd immunity means, you know, we’re going to need 60, 70, 80 percent of the population infected. And that means, you know, tens of thousands of people will be dead. It’s sort of Malthusian or, or, or a creepy utilitarian notion to think that we can sacrifice, you know, our grandparents or parents, the infirm, the immunocompromised for this notion of herd immunity.
The Swedish example didn’t bear itself out. The Imperial College study that came out on Sunday said probably around four or five percent of the American public has been exposed or infected with the virus, and even in places like New York City, it’s maybe 16 percent, 15 percent. So there’s a huge, huge, huge difference between that and sort of achievement of herd immunity.
Opening up, letting people get infected means we’re also sort of saying tens of thousands of people, tens of thousands of people, potentially hundreds of thousands, are expendable, which is — it’s nuts.
MH: It’s nuts. The president says we could have a vaccine — and people talk about herd immunity normally in the context of a vaccine — he talks about having a vaccine ready to go by the end of this year. Even Dr. Anthony Fauci and Dr. Deborah Birx on the White House Task Force have said January 2021 could be a possibility for a vaccine if some corners are cut.
Dr. Rick Bright, the Department of Health whistleblower, who was the former top federal government vaccine official, says it could take 18 months minimum, in his view, if not longer. William Haseltine, the scientist behind a lot of groundbreaking research in HIV/AIDS and cancer, he said recently: actually, we may never get a vaccine, we should prepare for the fact that we might never have a working vaccine.
Where do you stand on that spectrum, on that timeline? How long do you think it’ll take to get a deliverable working vaccine to hundreds of millions of people, if at all?
GG: Now, if I knew the answer to that, I’d be a very rich man, because I would be investing in, in, you know, vaccine companies right now.
I, you know, it’s interesting that I, you know, I’m old enough now to remember when Margaret Heckler, who was the Secretary of Health and Human Services in the U.S. in 1984, after the discovery of the HIV virus, that in two years we’d have a vaccine for AIDS. It’s now 2020. It’s many, many years ago.
So, you know, yes, technology has come a long way. We know much more about the immune system, how viruses work than we did, you know, in the age of Ronald Reagan. But the point is, is that vaccine development is generally denominated in, in years and decades, not months and weeks.
What’s encouraging to see is that there’s an enormous effort in the private sector, in the public sector to compress vaccine development by recruiting people for trials, compressing the phases of vaccine development. But then you run up against sort of the scientific obstacles themselves, and you can’t, sort of muscle your way past them, basically, by the force of your will or perseverance. And so we’ll see, you know — I’m hoping that we will someday see a vaccine for Covid-19. We’ll see one for HIV.
MH: You sound skeptical that we’ll have one in January 2021, in six months time.
GG: I’m not a betting man. But I don’t, I would bet that we’re not going to see one in six months time. And I don’t, you know, I think people are peddling a little bit of false hope to think we’re gonna even have it within a year to 18 months.
MH: It’s interesting you mentioned false hope. One of the things that frustrates me is I wish we had leaders who could tell us that, you know what, this is, in many ways, the new normal. We’re not going to go back to business as usual. We’re not going to go back to, you know, what life was like before anytime soon. Am I wrong to think that, that we need to actually kind of dampen some people’s hopes and expectations and get them more prepared for the new normal?
GG: Yeah. And you know, what’s sad is that, you know, Donald Trump and Boris Johnson are not those people [laughs], are not those politicians.
MH: [Laughs.] Yeah, certainly not.
GG: But Angela Merkel and others have been much more forthright about what the — what lies ahead for their countries, and Jacinda Ardern in New Zealand, and so I think there are, there are, there are leaders out there who are saying: ‘Look, alright, we thought we’d contain this, and now we’ve seen 200 cases’ and now, they massively scale up testing and contact tracing to a level that seems astounding to us here in the U.S..
MH: And in the absence of a vaccine, what is the safe way, if any — you know, we talked about going out and, you know, going to the grocery store and, you know, managing risk. But what about those people who, they don’t want to go to bars or they don’t want to go to crowded sports events or beaches, but they do want to see their parents, who they haven’t seen for several months, they do want to see their best friend who lives down the street. Is there a way of doing that safely right now?
In the, in the UK, they’re talking about, you know, expanding the circle to one family, one family can meet one other family now, is that something practical?
GG: Yeah, this is consistent with the idea of harm reduction right? Is that you’re not going to eliminate risk, you’re gonna reduce risk. The goal is not to, again, bubble wrap ourselves for eternity, but to figure out how to reduce our day-to-day risks.
So, you know, my sister and her kids and her husband went out to see my mom a few weeks ago. They did it on a sunny day, they did it six feet apart, they did it with takeout, they did with gloves and masks, and they were able to see people they loved and do it safely. Opening up your sort of contact network to another family seems like a reasonable thing to do as long as you’re, you have some ground rules about what that means. It’s an increase, increasing risk, but if you trust them and you say, “Look, you know, we’re not, we’re going to figure out, you know, two of us are going to go to the grocery store. That’s it. One for this family, one for this family. We’ll combine some of these errands and minimize our risk together.” That’s good.
That’s the point is, is to figure out how we do this over the long term. The biggest fear for me is people who are working meatpacking plants or who are locked up in prisons —
GG: — who have no choice in the matter. That’s the scariest thing for me. Because middle class, middle class and upper-class people have the luxury of sort of finessing the next few months to years. The people who are in, in sort of mandatory face-to-face contact on a daily basis, who I fear most for.
MH: Last question for you, Gregg. You’ve said that trying to control an epidemic in one part of the country, while not controlling it in another, won’t work. You’ve compared it to creating a peeing section in a swimming pool, because there is no such thing. Obviously, it wouldn’t work in a pool.
Given, in the United States, there is no uniform federal response to this pandemic, and you have some states taking it seriously, some not so seriously, and that’s not going to change anytime soon: Does that mean we’re screwed?
GG: Look, first of all, Carlos Del Rio from Emory came up with the peeing in the swimming pool analogy. So I need to give credit where credit is due.
MH: [Laughs.] But the point is, is that viruses don’t respect borders, right? You know, we saw that in the beginning of this epidemic, as it spread from China, then how it spread around the U.S., and how it spread around the world. It’s certainly not going to respect the borders between Connecticut and New York where I live, or Arizona and, and its neighbors, or Alabama and its neighbors. The point is unless we control it everywhere in the U.S., we’re not going to control it anywhere.
And it, you know, takes me back to the question, the statement I just made about people in prisons or places that are going to remain hotspots until we address the enhanced risk in those places, which goes to confront the way we think about incarceration in the U.S. as well. So it’s not just gonna be controlling this in our, in our wider communities, in all 50 states and territories in the U.S., but in the places that we tend to forget the — among the homeless, among the incarcerated, among people in ice detention centers and other places that will provide kindling for the next, next resurgence of the virus that we might see coming in the next few months, or maybe as late as this fall.
MH: That is very, very true. Depressing, but very true. Gregg Gonzales, we’ll have to leave it there. Thank you so much for enlightening us on Deconstructed.
GG: My pleasure, anytime.
MH: That was Yale professor Gregg Gonsalves, reminding us of the challenges, the huge challenges we face with the coronavirus, but also the ways in which we can all manage risk.
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