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'No area is particularly safe' from COVID-19: John Hopkins Doctor

Dr. Brian Garibaldi, Johns Hopkins Biocontainment Unit Medical Director, joins Yahoo Finance’s Zack Guzman to discuss the rise in COVID-19 cases as single-day deaths in the U.S. top 1,200 for first time since August.

Video Transcript

ZACK GUZMAN: I want to focus on the metrics that we're seeing play out here on the coronavirus front because things are starting to look really, really bad. We've been highlighting the case count here, the daily case count, which edged up by nearly 6,000 cases yesterday versus where we've been sitting at. It's close to about 60,000 cases now here.

That's not far from the peak we saw back in July, around 70,000 new cases being reported a day. But now worse yet, the number of coronavirus deaths reported in the United States yesterday reached the highest level that we've seen in two months. The nation was averaging about 700 a day for much of October, before rising to hit more than 1,200 deaths on Wednesday, according to Reuters. That's the highest number that we've seen since August 19.

So what's really going on, and which direction are we heading, as we head into those colder winter months? I want to break that down with our next guest here. That would be Dr. Brian Garibaldi. He's Johns Hopkins Biocontainment Unit medical director and was a consulting member of the medical team that cared for President Trump after he tested positive for COVID-19 himself.

And Dr. Garibaldi, it's good to be chatting again with you. First off, just where do you see where we're sitting at right now? Because we've been watching case counts rising in Europe. That's leading to lockdowns again. Obviously, there's a lot of differences in terms of where we go and thinking around lockdowns, coming back here in the US. But what's your take on where we sit now?

BRIAN GARIBALDI: Well, I think we're all really worried right now about where we are heading into the winter. There's a lot of worry about what happens as people go inside and spend more time congregating in higher risk spaces. We're also worried about what's going to happen with the flu season, if we see a big spike in cases and hospitalizations related to that.

And we're going into this high risk area at levels of virus transmission that are almost as high as they were back in the summer. So I think many of us are concerned. You know, we're all batten down the hatches in terms of making sure that we have the appropriate staffing models in place if we see another surge in ICU care, which we're hoping we don't see, but we might.

And there are already some hospital systems where more than half of their patients are back up to being COVID-19 positive patients. So that's not going to be sustainable as we move into the winter months.

ZACK GUZMAN: I mean, when you talk about the issues around this, there are people who might point back and say, look, you know, there's a few studies out there saying that the outcomes of hospitalized COVID-19 patients have been improving, seemingly suggesting that doctors are getting a better control on helping patients overcome the infection here.

And you yourself helped President Trump. You remember that medical staff there as well, as he battled it. So talk to me about what you learned through that process and whether or not you think that is what the data is showing here in that patients might be able to have outcomes similar to what the president had in coming out the other side fully recovered.

BRIAN GARIBALDI: Well, what we're seeing in terms of outcomes is partly due to some of the medical therapies that are available. So you know, things like dexamethasone and perhaps remdesivir have shown some benefit in reducing days in the hospital, and in the case of dexamethasone, reducing death.

But I think we're also seeing a combination of who's getting sick right now. By and large, we have had a younger population that's gotten sick recently. And much of our mortality early on in March, April, May to June were nursing home residents, who more than 40% of the deaths upfront were related to nursing home patients. We've done a better job, by and large, of protecting those at-risk populations.

But as we've seen, when those spikes start hitting certain levels of the community, no area is particularly safe from the virus. And we're starting to see, again, some scattered outbreaks among nursing home residents when the community transmission starts getting to a high enough level.

ZACK GUZMAN: And obviously, I mean, you were there. You were treating the president. You saw everything firsthand there. I mean, when that happened, did you sense maybe a shift in the idea that, look, you know, testing-- we know that the White House leaned in on testing there.

Did you get a sense that maybe there was a realization that, you know, this is something very real happening within a lot of different social circles, and that the virus doesn't necessarily, you know, treat one group of people different than another group? What was your sense in maybe how it might have changed the administration's take on how serious of an issue this is and how much farther you need to go, rather than just testing and relying on that?

BRIAN GARIBALDI: Well, I think it's an important reminder that testing doesn't prevent disease transmission. And if you design the best testing strategy in the world but it's not coupled with specific mitigation practices that we know are helpful, there's still the potential for transmission.

And so, yeah, I think it's a really important reminder as we start heading into these winter months and we're going to be indoors more, we need to remember to distance where we can, wear masks, you know, where possible, and recognize that being inside is going to be a higher risk environment than being outside. And so I think we need to sort of tighten up our behaviors and recognize that this virus can happen to anyone.

And it's happening right now. You know, a lot of the transmission that's happening right now is not large scale social events. It's small gatherings where people are comfortable around friends and family. Those are just as high risk an activity as a larger event with strangers or people you don't know that well.

ZACK GUZMAN: You know what's interesting when you talk about trying to button up the activity here, there has been, I guess, a subset of the scientific community that's come out and pushing and talking about herd immunity, something, of course, that you would like to see come through once vaccines, if they do get approved, getting administered to the public, that's where you would hope to see things go.

But there is a small camp talking about something referred to as the Great Barrington declaration, which is this idea that you could have younger populations that are less susceptible to dying from the disease going out there, getting it on purpose, protecting some older, more susceptible populations there.

But there's a lot of questions around that strategy and how many deaths can come as a result, similar to what we saw play out in Sweden. A lot of critics would point to that saying that, look, you had a similar impact on GDP there, even despite the fact they let everyone run around without lockdowns. So talk to me about that idea of herd immunity being addressed by letting everything stay open to the fullest extent, and how that might not be a great strategy in your mind.

BRIAN GARIBALDI: Well, the issue with that idea is that the only realistic way we're going to get to herd immunity anytime in the near future is if we have an effective vaccine. So I think there's been a lot of hope in whether or not we're going to be able to have an effective vaccine sometime this winter. There's a lot of different candidates that are in varying phases of trials. And hopefully we'll have some more information soon about the likelihood that one of those vaccines will be ready for wider distribution.

But I think, you know, by most estimates, less than 10% of our-- way less than 10% of our country has been infected so far. And in order for us to get to herd immunity, which, for this virus, might be around 60% or 70%, based on some estimates, you know, hundreds of thousands, hundreds of millions of Americans are going to need to be infected with this virus.

And while it is true that younger patients are less likely to develop severe disease or death, they're still going to develop severe disease and death. And they're going to have long-term potential complications with lung disease and heart disease and vascular disease.

And so I think relying on this idea that we can allow healthy people to get infected and not have some consequences, both in terms of hundreds of thousands of deaths, as well as hundreds of thousands of people who are going to have long-term complications from the virus-- it took years before we understood from the 1918 influenza outbreak what some of the long-term sequelae might be. So we don't really even understand yet what long haul COVID might look like or what some of the long-term complications might be.

I think there's also-- it's an illusion that we can protect certain elements of the population. If there's widespread community transmission, how are you going to protect intergenerational households? How are you going to prevent healthcare workers from spreading into nursing home populations that they have to take care of? So I think this idea that we can allow natural infection to get us to herd immunity without horrible consequences in terms of health and death I think is-- I think it's a dangerous idea.