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27 Mar, 2020 08:07

Covid-19 pandemic will end within next 6 months – epidemiologist

The novel coronavirus has locked us all in our homes, but the show goes on – though in a bit of a different format for now. We asked Michael Favorov, epidemiologist and president of DiaPrep System Inc., all the important questions about the virus.

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Sophie Shevardnadze: Michael, welcome to the show. So many questions about the ongoing pandemic. So there are a lot of truly deadly diseases with a significantly higher mortality rate than COVID-19: Ebola virus killed 40 percent of the infected people, bird flu — 39%, swine flu - 17%. How come that this virus, not the world's deadliest by any means, put the whole planet on a lockdown? 

MF: That's pretty much the question for the psychologist, not for the infection disease specialist, but nevertheless, the answer to that is that we have a significant disease which is deadly for certain population, which is deadly for elderly people and elderly people. I have a percentage, like 15 percent among those who are getting the disease. And I think it's pretty much the level of, let's say, plague or even smallpox. So if you have a certain group which is negatively selected by a high level of mortality, that really makes people very nervous, they’re not necessarily understanding that young people are not affected as much. 

SS: But now, I mean, before we get to the age groups that are under risks, do you think it can potentially become something as deadly as the 1918 Spanish flu that killed millions of people? 

MF: I think the main issue with the Spanish flu was the situation, the world’s situation. You have to realise that, first of all, it was the first time the civilisation actually found itself in a much worse situation. People understood what was going on that it went through the cross-species, went through the new pathogen of zoonotic disease, which influenza and coronaviruses are. The first time this happened... And of course, nobody knew what to do, nobody actually prepared for that. And on top of this, even worse, that was the First World War. The millions of people were dying on the field. And who cares if, you know, somebody in the civilian side is dying too. And that's I think, again, that's all the psychology, or the mass psychology, especially later, especially nowadays they become an incredibly, incredibly important subject. 

SS: OK. So I'm young, I'm in good health. I don't smoke. And they tell me I shouldn't worry about the coronavirus because if I get it, I'll most likely have a mild form of it or, you know, I don't risk death as much as elderly people. But do we know what the long-term effects of carrying COVID-19 can be? I mean, can it be, for instance, raising the risk of lung cancer in the future or cause potential pathologies in other organ systems? 

MF: No, no, no, no. We have no data on that. That's only speculation, you know, now everybody has suddenly become an epidemiologist. There’s no data on that whatsoever. We have a very mild acute respiratory disease. That's like rhinoviruses or influenza, if you want. And there's no evidence that it's any chronic or manifestation to any kind of cancer disease or whatever. I categorically disagree with that. What I'm saying is that, yes, as a new infection, nobody has any antibodies. We're all like, you know, the entire population of the world is not protected. This is the biggest issue because whoever gets the virus, that person will be infected. But what does it mean? Only a small portion of people will actually be having the disease and among those who will have the disease, WHO shows, that it's only 6 percent who will have a disease will need to be hospitalised. It means we have a lot of light forms like you describe, and that's you know, that's quite a simple disease and self-resolving disease. And we have a huge, I don't know, maybe millions of people who were actually just immunised after their contact with the virus, they have antibodies. They've never even thought they had the virus. That's why the Wuhan outbreak has stopped. Otherwise, how would it stop? Yeah, the measures... Come on, guys, you have to realise that all the measures only can postpone the disease but not prevent it. So the answer is no. You're safe. Don’t worry about it.

SS: OK. So here is the million-dollar question. Do those infected with COVID-19 develop immunity against it? Let's say I get it. Am I likely to get it again like we get influenza, for instance, or flu or am I not ever gonna get it again? 

MF: Absolutely. You develop immunity, you will never get it again. 

SS: Wow. 

MF: Yeah, that's it. At least for now we know that SARS — you remember the similar virus? 

SS: Yes. 

MF: Which has tried to do a cross-species jump out of bats in 2003. It provided the protective immunity for at least five years. But we don't know because nobody followed after that. It means, let's say this week what we know now that the current coronavirus will probably give you the same five year guarantee of no-repeat of the disease. I have to tell you an important story. There wereseveral publications about the so-called secondary cases of coronavirus. And anyone who’s listening to us will say, “oh, Michael, what do you say? We already know that they had secondary-cases of coronavirus and some people have already died.” Yes, there was a report of death among secondary cases of coronavirus. Guys, we have to realise that that's created by us. That’s created by the human approach to coronavirus control. We have a test. There’s no such thing as an absolute test, which would give you an absolute truth.  Any test gives you from 5 to 1 percent of false positive data. It means we will take somebody who is not infected at all. And there is a chance of one percent that the person will be tested positive by our test. But in reality, this person is not sick. What's happened to this person in Wuhan? He would immediately get into the quarantine at least, if he had no symptoms they would put you in the stadium with 10 thousand other people who are positive. What's happened to the person? The person gets the disease infection and the person will be discharged from the hospital during an incubation period, develop their own disease because he was infected and currently gets back to the infection and…

SS: So what you're saying is that it's basically just the mismanagement of humans that leads to the second case of COVID-19, but not that if you get it once you can never get it again, or at least for five years, right? 

MF: Absolutely. 

SS: So look, in China, the coronavirus was most aggressive at the very beginning. And then it became less scary as a lot of people were getting flu-like symptoms and some had… they didn't even have symptoms at all. Should we expect that COVID-19 will soon mutate into an ordinary respiratory disease that will be, you know, more or less harmless?

MF: Yes. From the very beginning, the first time I presented it for the RussianTown Magazineand TV, I said that any zoonotic disease in the beginning is very severe. Why? Because the virus gets to the wrong host. Everything is wrong for the virus, and the virus crashes everything because it's all wrong. But going through the first cases and the second cases the virus has adopted. And it's why over time among zillions of types of viruses we have more severe and less severe types of the viruses. And Korea is a good example of the less severe virus. So they have a significant outbreak, but they have only 0.5 mortality percentage, again, among adults. But it's ten times less than what is going on in Italy.

SS: So when we look at pandemics, it follows a common scenario, as far as I understand, it starts then it spikes, then it sort of peters out. Does that mean that you can adopt all kinds of strictest measures, put entire cities on lockdown but none of it will work until the critical mass of people gets infected until the peak is past us?

MF: Yes, you're right. But give me a definition of “it's not gonna work.” If you mean “to clear the population of the virus,” you're right. But that's not the goal of the quarantine. The goal of the quarantine is that we all get sick slowly. If we all get sick within a month, the medical system will collapse because there will be an unprecedented number of dying people.Even the system of I’m sorry, cleaning the streets of the dead bodies wiil collapse. That's our main goal — to make it longer, to make it slow. In this case we have several hopes. First of all, the system will continue to work. Severe sick people will have enough help for their treatment. Second, we are waiting for the treatment. That's very close. Now, we know that many drugs are in the trial and that speeds up the trial. People are working 24/7 to get the drugs. We'll have it soon. Then we are waiting for the vaccine. Again, everybody's going crazy about the vaccine. Everybody's working on it. It means it's gonna happen. So we have the whole series of issues, which is very important to slow down the epidemic. That's what the quarantine is all about.

SS: There's a question that bothers me all the time, because I've been told and I understand you've confirmed that some people can have COVID-19, but do not feel it, don't have any symptoms. 

MF: Most of the cases, that's an absolute majority of the overall infection. 

SS: So you don't feel anything, like, no cough, nothing? 

MF: No.

SS: And then that means that I can take as many precautions as I want and not feel the COVID-19 when I have it and infect my parents who are 60 plus if I live with them?

MF: Right. That's the biggest issue. You may not even know that you have the virus. But you come to your parents and they get it. And they might have a severe disease. That's exactly the biggest problem whatsoever. And that's why the Brits actually in the beginning of the outbreak, they said, “OK, young guys, you can go to your life and even go to the pub, we're not closing the pub”. It's very important in Britain. But complete isolation for the elderly.

SS: So what do you think is the best approach? I mean, the whole herd immunity that Britain was going for but didn't completely do at the end? Or what people are trying to do now — cities on lockdown, prevention measures and sort of, you know, prolonging the wave of COVID-19 to spike? 

MF: I personally support the Brits’ approach because it's not one way or another. That's a dynamic process because an epidemic is a dynamic process. Something happened in the beginning, something happens when... something happens during the resolve. It's all different stages of an epidemic. It's a different type of response, which we need to implement in these cases. What Brits did was they keep as many contacts among young people as possible targeting their herd immunity and isolate elderly. Unfortunately, at the moment of peak, which they’re going through now, they have too many cases, too many cases. They have to stop it because they have to delay the coming new cases. And they even ask retired nurses and doctors to come to hospitals and help. It means that the system is overloaded. They are doing the right thing, now they locked up the city, “don't go anywhere.” You know, because it's pretty much a very immediate response because the virus incubation period is, let's say, one week. And if you lock it, it means you will have less cases in a week. I think it shouldn't be one way or the other. In many post-Soviet countries, they just locked their countries and hope for the best. But sooner or later this virus will make its way in. You can’t lock your population for a long time.

SS: Does it mean that the herd immunity doesn't work? If everyone is getting really sick and there is such an overload of the health system and they're asking for the retired nurses and doctors to come to the hospitals to give them a hand, does that mean that the whole approach of herd immunity didn't really work? 

MF: No, I did not say that. In Britain we have a [lower] mortality rate, in Britain, we have an adequate system of treating the elderly and probably because we don't have a test yet, we already have a significant portion of people who are immune. I think it has worked. I think it's even better than any other example we have, like we have Italy or where the beginning was very open. And Spain where they tried to lock... I mean, your conclusion is possible but, unfortunately, we can only answer all these questions after the outbreak, when it’s all over. 

SS: But is there any way of knowing? I mean, how do we know when the worst spikes in numbers are coming? And can we predict how big they will be so that the hospitals could prepare? 

MF: Very easy. I think it's on my Facebook. If not I will do it today because you ask the right questions. You put all outbreaks and how they developed in one graph and you see immediately that all develop in the same way. You just put your numbers of today to that graph and you will see, you know, +/- a hundred cases a day, but you can see how it's gonna be in your country. You're right. Yes, that's quite possible.

SS: But what exactly is our healthcare system missing to be able to deal with a large volume of infected people? Why are they missing it in the first place? 

MF: How do you think the medical management is working? Based on what? It's working on the number of necessities. Let's say, with no outbreak, we have a number of hospitals, number of isolations, number of equipment that's actually purchased and built up because of existing patients. It means year to year somebody is already using this equipment, somebody is already in intensive care. Nobody builds up extra intensive care for nothing. And certainly on top of that, you have even just 200 cases. What to do with that? What to do with the people who already occupy the equipment because they couldn't breathe? That's because it's additional, we are never ready for whatever that’s additional. We’re always focused on being very economical and not spending any extra money for nothing.It means if you have an outbreak, you need extra resources and it's very difficult to do. 

SS: So the pandemic — I'm just looking at it globally. Do you think pandemic is a sign of what the next decade will be like? SARS was a minor nuisance compared to this. Is it only going to get worse every time? 

MF: No, I think humans will learn from that. SARS was really bad but it was contained too fast for such a huge population as the current civilisation to learn from it. It was too weak. If it was all the way round, if COVID-19 came during the SARS time, now we would never have SARS because after that outbreak they would probably realise that if they go thousands miles from Wuhan, get the bats there, bring them to the institute in Wuhan and suddenly find some of them in the Wuhan market - that’s probably a very bad thing to do. And yeah, and I think that they will actually significantly restrict the purchasing and all the businesses which in many parts of the world people are doing with the wild animals. Ebola — same story. They found the new bats which became kind of, you know, very popular, huge, it's actually the flying fox. That's huge, you know, they started catching it, they took it to the bazaar. You can come there and buy it and you get Ebola. Yeah. Welcome to the real world. It's all the same. No new disease was new to the environment. It's something that was always in the environment.

SS: Michael, after the first wave of measures work and the first batch of people actually stop spreading the disease, the quarantines end, everyone stops washing hands, eating wild game, and the virus makes a comeback. How serious will the second peak be? What can we do to keep that under control?

MF: I think it's a question for the Chinese government where wild animals are extremely popular because of their traditional medicine. You know, they have all parts of bodies of a big range of wild animals. I used to work in China. I've been at that exotic bazaar. It's always amazed me how popular all these pieces of the animal's body are, the bears, the tigers, whatever. But with the bats, we have a very significant consequences of that. And in Africa, of course, Ebola is a great example of how careful we have to be about this. I think it's relatively easy to prevent. You know, China is not… whoever is kind of doing whatever they want to. As soon as they realise that that's probably the danger they will stop it. Trust me, I’ve been to China many times. 

SS: Hopes are really high that the virus may be seasonal. We hear a lot that, you know, countries where there's a lot of sun and it's humid it doesn't spread that much there. What do you think? 

MF: Well, yeah, from the very beginning, I was not the first one who told about seasonality. The first one was the CDС, my alma mater where I used to work for twenty five years, they published that it looks like or we hope that the virus is seasonal. And then I found some indirect evidence for that in my work in Central Asia. I just came back from Uzbekistan where there are very few cases — anywhere in Central Asia there are few cases. I looked at a number of respiratory diseases, overall diseases in Central Asia right now. And I show that there was even less than a low level of respiratory diseases last year, during the low season, it means that the season is very important…

SS: But then how come it is raging in Iran? It is raging in Saudi Arabia, I mean, the climate is pretty hot even right now over there. 

MF: Saudi Arabia, it’s a very interesting question but I don't want to go there, but I don't think that it's a really big epidemic. It's not. That's a very, very small one. Iran — it’s a nightmare. It's a catastrophe. And it's, again, the result of human error.Italy is a human error. They do not know the first case, what was 10 days, including intensive care. 10 days in a regular hospital? What do you think?! There were sick people there, on top of that there was a virus, and they distributed it for 10 days, it’s a long time. 

SS: We only have like a minute or two left. And if we may, just give a little resume. It's a million dollar question, two questions. When do you think it will end? And how soon are we gonna get a vaccine? 

MF: I think it will end within six months, like take China. And the vaccine, again, it’s a very difficult question because what do you mean? I think some group of people get that within a year and the rest of the world within 2 years. That's what I think.

SS: Michael, thank you so much for this wonderful insight. It's been amazing speaking to you today and hearing answers to some of the most vital questions that are bothering everyone right now. Stay safe. Stay home. Thank you so much. Take care. 

MF: Thank you. Appreciate it.