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Many states ‘don’t have the infrastructure or political will’ to deal with coronavirus: Johns Hopkins Infectious Diseases Expert

Cases of coronavirus spiked over the weekend in the United States, with Florida shattering daily case records with 15,000 new coronavirus cases in a day. Dr. Amesh Adalja, a Senior Scholar at Johns Hopkins Center for Health Security, joins The Final Round to discuss the latest on coronavirus.

Video Transcript

- Want to bring in Dr. Amesh Adalja. He's from Johns Hopkins Center for Health Security, a senior scholar there. Dr. Adalja, thanks for joining us. What is your reaction to the headlines that Anjalee just walked us through, first with the rising number of cases and then what we're seeing out of California and the fact that the state is rolling back some of its reopening measures? And then also the announcement that we got from the LA public school system the fact that students will be returning to school-- or they won't be returning physically-- they're going to be doing it virtually in the fall?

AMESH ADALJA: What I think we see is that many states, even ones that we're very measured and they're reopening like California, simply don't have the infrastructure to deal with cases. We know that testing, tracking, and isolating is the way that we will deal with this. But many states have just not had the political will to actually implement those types of measures. And there was another story in the "LA Times" over the weekend talking about how badly testing and tracing has gone in California.

So this is something that we really have to, as a country-- if we're going to live with this virus, we actually have to have an apparatus to do so, because I don't think the solution is going to be continually shutting down. Because this virus isn't going anywhere until we have a vaccine. So we have to get this right and not make the same mistakes that we made in January, February, March all over again. And that's what people are seeing-- this one blunt tool of shutting down, where we can actually do something like Taiwan if we actually had the political will to do it.

- I want to hit on the point about schools, because, you know, it seems like there is a debate about-- or maybe you can tell me that there is a debate at all about just how likely the virus is to spread among students. Is it really-- just is it just safe to shut down the schools altogether, as LA public schools system is now doing because there's just a lot of unknowns? Or is there a fine balance here between allowing students to return to some form of learning in person? You know, how do you measure the risks right now?

AMESH ADALJA: Well, what we know epidemiologically is that children tend to not be magnifies of infection the way they are for influenza. And there are places where schools have opened in Denmark and Finland. Even some US states like Idaho, Montana, Wyoming have opened schools without a problem. We can do this but you have to make sure that you actually have schools that have the resources to do it, because you're going to have to change some of the physical layout. That you're going to have social distancing, you may have people wearing face coverings. And you have to be worried about the vulnerable teachers and other people that might be there.

And you put a-- you need to put a plan into place. We don't want to rush it. We want people to follow the CDC guidance. But I do think that we shouldn't reflexively just say school is not possible. It's going to be challenging, especially in places that are hotspots, but I do think we know just like the American Academy of Pediatrics said, that keeping children out of school is actually harming them. So this must be something that should be a priority when we move forward, because it's really-- this isn't-- there's not a lot of science that actually supports the closure of schools. And I think it's something that people see as an obvious solution, but actually, when you look at the science, it really wasn't well supported, even when they were closed back in the early parts of this pandemic.

- And we've definitely seen some examples out of Europe of what can be done. But going back to the testing that you mentioned, I know that that's been one of the things that's been really a heavy focus-- is the continued limitations of testing capacity in the country as well as tracing not really ever getting off the ground in many places. How can we fix that and is there a way to really focus on that right now? Or is it becoming another sort of urgent situation the way it was in New York?

AMESH ADALJA: The thing is we've gotten much better at inpatient testing. So if you're in a hospital, you can get a test result back in hours. It's just the outpatient testing is not prioritized. They have reagent shortages, So they are really being centralized at the major national lab chains like Quest and LabCorp. And there's no way to prioritize who gets tested, which test gets run first, which one gets one second. So we have the seven day lag periods, which make the test basically worthless.

We really have to have a national testing strategy, where we can get the reagent to be able to do all of those outpatient tests as rapidly as they're being done inpatient. We can't have people waiting seven days and expect to have any kind of semblance of normalcy or people feeling safe that they can go out, because this is really-- the cornerstone of all of this is being able to test to know who's infected and who isn't. And we're clearly behind when you have people waiting in our car for eight hours in Arizona to get a nasal swab.

That's just not acceptable. That's not something that's going to lend itself to being able to live with the virus. Everybody wants to live with the virus, but you actually have to have it await a plan a way forward the way Taiwan did it, for example, if you're going to actually come to that conclusion that we're going to coexist with this virus.

- Dr. Adalja, I share your outrage and the testing, and it's not seven days either necessarily. It can be longer. I mean I know people up here in the New England area who are still waiting 11, 12, 13 days later. And, you know, you're supposed to keep yourself indoors at that point while you wait for your test results? I mean, it's ludicrous and it's really a disgrace for our country that we're in this situation this many months later.

But I want to ask you actually, just a technical thing about the Johns Hopkins metrics, because, you know, they have become, I guess, the standard for us to track the progress of the disease and the fight against it internationally. How did that come about-- just some sort of behind the scenes info there?

AMESH ADALJA: So I'm not someone that's actually directly involved in that, but some of my colleagues are. And it was just trying to formalize the way that we collect data, allowing that to be a guide to action. And it started with the map that everybody has seen that was developed by some engineers. And now just a real emphasis on trying to get testing to a place that's good in this United in the United States, and having a way to measure how different states are doing. So we really think it's just a commitment to trying to get that analytics out there so that people can actually do this in real time. I wasn't involved in the behind the scenes stuff, but it is very useful. And I myself use it all the time when I'm trying to think about where this pandemic is going.

- Dr. Adalja, I'd love to hear thoughts on the news having that we got today out of Pfizer and Bioentech-- the fact that the FDA has-- been granted FDA fast track designation for two of its vaccine candidates. What are your thoughts on that? How optimistic are you about this? And then the ongoing studies are successful, I guess what should we be expecting in terms of timing these?

AMESH ADALJA: I am very optimistic about a coronavirus vaccine, and I do think that some of the big pharma players like Pfizer, who know how to make vaccines, is even more reassuring, because we know that they can manufacture at scale and know how to do this.

I do think, though, that you have to remember vaccine development is something measured in years, not months. And we may have some vaccine available at the end of 2020 or early 2021, but clearly not enough to vaccinate the entire population. And we have to make sure that have a protocol for who we're going to administer this to. There's likely going to be tiering, meaning that health care workers, high risk individuals may get it first. And we also have to think about what problems might happen when you manufacture at that big of a scale.

And Operation Warp Speed is something that's trying to alleviate most of those concerns, But I do think we-- we're going to be prepared to-- we have to be prepared to fight this virus without a vaccine for probably up to two years before we get enough people vaccinated in the United States if everything went perfectly. I think that's the scenario I keep in my mind.

- Up to two years. All right, Dr. Amesh Adalja of Johns Hopkins, always great to get your perspective. We look forward to having you back soon. Thanks so much for taking the time to join us.