What Needs to be Done to Deal with COVID-19 in China: An Interview with William Haseltine
William Haseltine, Chairman, U.S.-China Health Summit; Chairman & President, ACCESS Health International
Interviewed by Dr. Jing Ma, President, U.S.-China Health Summit; Associate Professor, Department of Population Medicine, Harvard Medical School & Harvard Pilgrim Health Care Institute
Since the first reported case of the coronavirus (now officially named COVID-19) on Dec. 1st, 2019, according to the Lancet Paper, more than two months have passed. Three weeks ago on Jan. 23, 2020, the city of Wuhan was shut down and approximately 20,000 health professionals from all over China were sent to Wuhan and the Hubei Province to support local medical institutions. As of Feb. 13, 2020, 9:00 am (EST), there are a total of 59,901 COVID-19 cases (13,435 new cases compared to the day before) and 1,368 deaths. The corresponding numbers in Hubei are 48,206 COVID-19 cases (14,840 new cases compared to the day before) and 1,310 deaths, exceeding the total number of deaths from the 2003 SARS outbreak.
To combat the COVID-19, Dr. Jing Ma, President of the U.S.-China Health Summit and Associate Professor of Population Medicine at the Harvard Medical School, together with Dr. Yuanli Liu, the Dean of School of Public Health, Peking Union Medical College (PUMC), have been leading a team of 30+ volunteers working closely with global public health experts and Chinese healthcare leaders to monitor the spread and virulence of the virus within and outside China, track international scientific research findings and experiences, and communicate with Chinese public health institutes and healthcare policymakers.
William A. Haseltine, PhD, has gained extensive experience in the fields of public health due to his professorship and research at the Harvard Medical School and Harvard School of Public Health from 1976 to 1993. He has also developed expertise in large-scale organization structuring and development as he initiated the Division of Biochemical Pharmacology and the Division of Human Retrovirology at Harvard, and serves on advisory boards for numerous international entities varying from the Brookings Institution to the Council on Foreign Relations.
Using his knowledge in both the medical and administrative fields, he provides a fresh perspective on what can be done in China to improve management around coronavirus outbreaks. He notes the absence of readily available and developed prophylactic drugs to protect people during the early stages of infection which, in turn, would prevent the spread of the disease. Another issue that he addresses are the challenges with hospital-centered healthcare systems in large countries such as China.
Comparison to past epidemics: In comparison to the flu virus, COVID-19 is not as transmissible, but it is often more lethal, especially for patients with weaker immune systems. COVID-19 is also different from ebola, which is highly transmissible through close contact and lethal for almost all untreated patients.COVID-19 and polio share some similarities in that most patients do not have severe symptoms, but a small percentage do.
Need for national support and institutional collaborative effort: China needs to provide incentive and government support for general research on coronaviruses prevention and vaccination, as well as for the development of anti-flu and anti-coronavirus drugs in preparation of future epidemics.
Health care infrastructures: Hospital-based healthcare systems will not work for China, especially during outbreaks of infectious diseases like COVID-19. Providing an affordable, accessible, and equitable healthcare system in an integrated and distributed way minimizes the rushing in of all kinds of patients, which can cause cross-contamination and infection. It is also necessary to improve the connection and communication between the CDC system and the hospital systems through improved public health information systems.
Education and preparation in advance: It is important to have realistic projections for the future as new virus strains often emerge and can result in big epidemics. Properly educating and preparing health professionals in advance is a good way of mitigating the effects of new strains.
International collaboration: There is a need for countries to work together to offer each other immediate, transparent and practical support.
Economic consequences: While projections have been made by economists, there is a lack of understanding of the potential spreading of the COVID-19 among Southeast Asian countries.
1. Is the Wuhan Pneumonia pandemic worse than any other public health emergencies such as MERS, Ebola, and SARS?
It's still a bit early to tell. This novel coronavirus is not as transmissible as the flu virus, but it is more lethal, especially for those with weaker immune systems, such as seniors and people whose lungs are compromised. In my view, the number of deaths from COVID-19 will likely not exceed the number of flu deaths per year – flu deaths in the United States range from 12,000 to 15,000 a year. Yet, like I said, it is still early days and there are still many unknowns.
What we do know is that coronaviruses, as a general class, behave like a cold virus. In fact, 30% of all cold viruses are coronaviruses. So we have a basic understanding of the behavior of these viruses in terms of how they are transmitted from person to person and how they act in various climates. What we are seeing today is a variant of coronaviruses. Every year there are new variants, just like there are new variants of other cold viruses.
COVID-19 is different from Ebola, which is very lethal for most untreated patients. Those patients have death rates close to 100%. It is also very, very easily transmitted by close contact, but not as easy to transmit as a cold virus is. Ebola can be easily controlled if a reasonably good health system is in place to identify, isolate, and contain its spread. That’s harder to do with more easily transmissible diseases like COVID-19 because there are many people with mild or no symptoms.
In my view, if the spread of this novel coronavirus is not controlled, then the best way to protect ourselves is to employ basic public health measures. For some viruses, such as SARS and MERS, once they go away they never come back. So the question now is, will this virus die out or will it spread and become chronic? My feeling is that it will probably die out and not come back. But that is just based on what we know about past lethal epidemics and what we know from other coronaviruses. The one thing we know with certainty is that coronaviruses are understudied and we need to learn more about them.
2. Why is the Chinese government so underprepared?
I'm not sure if we can say that any country in the world was properly prepared for this outbreak. First, all countries should have put more work into understanding coronaviruses in general after the previous two outbreaks of SARS and MERS. There should have been international teams of scientists and researchers across China, the United States and the rest of the world studying these viruses.
Neither China, the US, nor any other country has invested enough resources into developing a prophylactic drug to have on hand to protect those who have been exposed to coronavirus or who are in the early stage of infection during an outbreak. To remedy this, scientists, industry and governments need to work together to develop a combination of drugs that can treat infections and prevent infections from spreading. We probably have the drugs needed to do this on a shelf in a lab somewhere already but we need to create the market for the drug to be fully developed. It’s not something a private company will do on its own. A government will need to commit to stockpiling the drugs. I developed the first anthrax weapon defense drug. It is an antibiotic that neutralizes toxins and can protect anybody from getting infected. And if they are infected, even with an antibiotic-resistant anthrax, it will save them. That’s the kind of drug we need for coronaviruses. In the case of anthrax it was the defense department, homeland security and the Centers for Disease Control that incentivized the development of the drugs. The US government spent 500 million dollars to stockpile our drug. That’s what we should be doing now – developing and stockpiling an anti-coronavirus drug.
China has all the capabilities it needs to develop those drugs. The United States does too – BARDA and Project Bioshield are great programs that can incentivize companies to act against biological threats like this. France, Germany, China, Japan, and India all have the capabilities for doing this. Once one country finds a good combination of drugs, they should be made widely available; everybody should know what these drugs are.
3. There seems to be two approaches in dealing with the Wuhan coronavirus. In Wuhan, Hubei, they shut down the whole province. Singapore didn’t take such an extreme approach. What are your thoughts on this?
There is another major lesson here for the future: unless you are a tiny country like Singapore, large countries should move away from hospital-centered healthcare systems and move toward home care and community-based care. Building larger and larger hospitals is a dead end. Every time I speak at conferences, I talk about the need for an integrated health system where the majority of healthcare is delivered at home, in the community, and through a network of high-quality outpatient clinics that would be spread out across entire regions. This would minimize the work done in hospitals. Hospital-centric systems are not built to handle surges like those we see during epidemics. In fact, hospitals can be quite dangerous during epidemics, as they concentrate people in one spot and can contribute to new infections. Distributed healthcare systems will result in higher quality care that is more convenient and affordable.
4. What's your view on educating professionals in preparation for such outbreaks?
There is no question around the importance of educating health workers. It is absolutely important, especially as we embark on a path of more distributed and integrated healthcare. There is no telling what the next epidemic may have in store for us. My private estimate is that if we have another string of the 1918 influenza, up to 1 billion people could die. It could be 60% lethal. We know another epidemic is going to happen; the only thing is that we don’t know when or how deadly it will be. It is not in our best interest to be complacent or unrealistically optimistic about what may lie ahead.
5. What’s your view on the communication between the U.S. CDC and the Chinese CDC?
You know, in times of epidemic, there are two things that can stand in the way of success. One of those things is politics and the second is trying to put a human face onto a natural disaster. No one is to blame for this outbreak. It is like trying to blame someone for a volcano or a tsunami. If we work together, we will always be smarter and better than if we work individually.
6. What will the future health systems look like in China? In China, the CDC system is isolated from the healthcare system; the first alarm of the virus came out of hospitals.
It is important to connect the CDC to the healthcare system, but that requires a solid information system. The information available regarding age distribution, time of onset, and all the other details of the epidemic has to be high quality for it to be useful in helping others understand what is happening. That being said, there is great respect across the world for the scientific effort of the Chinese. The Chinese are doing a very good job in quickly publishing some of the sequencing and clinical data about the virus and what it’s doing.
(Jing Ma) Electronic medical record support of the Public Health System from the DPM could be helpful. It does not need manual import. We could start setting up this kind of connection of hospitals and CDC in Sichuan, although we will see a time lag in this system. We could include lab testing, CT imaging and all necessary information. That’s something the U.S.-China Health Summit can work with China on in the future.
7. CDC has had an epidemic information response (EIR) training program for 2 years. Someone suggested that China consider a kind of commander chain that can be mobilized and possess the authority to respond.
In the end, it really depends how long it goes on and I’m not sure we can predict that just yet. It may be better to train health workers that are already there as having them in them in reserve may prove too costly. But, costs aside, a special course that gives that kind of training to a broad group of people is not going to do any harm – the more people that have that training, the better it is for everyone.
8. What are some important consequences of this epidemic?
A lot of economists are making predictions about the impact of the outbreak on China’s GDP but how broad the consequences will be for other countries remains to be seen. The countries in Southeast Asia that are linked to China’s supply chain will likely be the most heavily impacted, but nobody has a good understanding yet of what will happen.
About Dr. Jing Ma
Together with Dr. Yuanli Liu, Dean of School of Public Health, Peking Union Medical College, Dr. Ma co-established the U.S.-China Health Summit in 2011, which has been alternated between U.S. and China annually. It becomes the major platform for exchanging ideas, communication and collaboration among top leaders in academia, medical services, policy makers and healthcare industries between the two countries. In 2018, Dr. Ma created the China Center at the Department of Population Health, Harvard Medical School and Harvard Pilgrim Health Care Institute and serves as the founding Director.
About William Haseltine
William A. Haseltine, PhD, was a professor at Harvard Medical School and Harvard School of Public Health from 1976 to 1993 where he was founder and chair of the Division of Biochemical Pharmacology and the Division of Human Retrovirology. He is well known for his pioneering work on cancer, HIV/AIDS, and genomics. He has authored more than two hundred manuscripts in peer reviewed journals. He is the founder of Human Genome Sciences, Inc., and served as the chairman and CEO of the company for 12 years. Dr. William Haseltine was listed by Time Magazine as one of the world’s 25 most influential business people in 2001 and one of the 100 most influential leaders in biotechnology by Scientific American in 2015.