Preparing for the Next Pandemic: 'It Is Inevitable'

John Whyte, MD, MPH; Tom Frieden, MD


May 01, 2020

Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

This transcript has been edited for clarity.

John Whyte, MD, MPH: You're watching Coronavirus in Context. I'm Dr John Whyte, chief medical officer at WebMD. Today my guest is Dr Tom Frieden. He's the former director of the CDC and president of Resolve to Save Lives. Dr Frieden, thanks for joining me.

Tom Frieden, MD: Thanks for discussing this.

Whyte: A lot of folks are talking about what went wrong with our initial handling of the coronavirus epidemic. Is that the best use of our time right now?

Frieden: I would like to focus on the future because we're still in the midst of this terrible pandemic, and we need to put all of our attention on doing now what we need to do to protect healthcare workers, protect the public, and reduce the health impacts and the economic and social impacts of this crisis.

Whyte: Where do you think we are on vaccines? A lot of people are saying that we need to keep social distancing to some degree until we get a vaccine. But we know that, historically, vaccine development has a lot of ups and downs, and often it can take decades. So how do we balance this desire to have a vaccine and start to have a relaxation of some of these mitigation strategies?

Frieden: On the one hand, we need to go full steam ahead trying to get a vaccine. But we need to recognize that that could take 1 or 2 years, or even more. At the same time, we need to prepare ourselves for a new normal. That means we need to strengthen our systems to track the virus so we can know when it's spreading widely and when it's beginning to recede.

We need to make our healthcare systems more robust so that fewer healthcare workers—ideally, no healthcare worker—becomes infected. We need to also be ready for a surge as we've seen in New York City and elsewhere so that our hospitals don't become overwhelmed. We need to be ready to take care of patients with chronic conditions, even in the age of coronavirus. That means more telemedicine, longer prescriptions (2, 3, 6 months for stable patients), more e-consults, and more safety in our healthcare facilities—more handwashing, more masking of everyone in facilities, more care for our nursing homes where there may be explosive spread.

This is an enormous risk and we're going to come out again. But it's going to be with a new normal of more handwashing and physical distancing, our elderly and our medically vulnerable shielded and sheltered for longer than others, and recognizing that we may have to go back to physical distancing if we get it wrong and if cases spike again.

Whyte: Are you concerned that with warmer weather, people are going to have a desire to get out there, they're going to be tired of social distancing, and then we're going to have a spike in cases?

Frieden: We are all tired of having to stay in. And we want to enable society to open back up as soon and as safely as possible. That's why we're promoting the "box it in" strategy: test, isolate, contact trace, and quarantine. Those four corners of the box, if we get those right, there will be cases in clusters, but we can box them in so that it doesn't explode and we don't have to run back into our houses again.

To open quickly is a risky experiment. This is not trial and error. We need to try to make sure we don't make errors that cost lives.

Whyte: You brought up the issue of contact tracing. We do know that many public health departments are underfunded and don't have enough staff. There's been discussion about the role of tech and how Apple and Google and others can help in that contact tracing element. What are your thoughts about the role of tech, and should we be concerned about privacy issues?

Frieden: Of course we should be concerned about the privacy. There are some things that Big Tech has done and can do that are really encouraging. One of them is looking at mobility surveys. Google and Facebook have published ways of tracking to what extent people are actually physically distancing. That's important so that if it's not going well, we can figure out how to message that better and keep people safer.

They're also looking at things like symptom surveys, which may be early warnings of where the virus is beginning to spread that would allow us to physically distance in a more nuanced way for shorter periods of time and more tightly connected to viral spread. There are also things that groups like Pinterest are doing to allow people to get education about whether they have the symptoms of COVID-19.

And there are some standard workflow technologies—call center, work allocation, database management—that, frankly, public health is behind the curve in and needs to be modernized. And there are also some really important things that we think newer applications can help traditional contact tracing to do.

But what we are concerned about is the idea that's sometimes called proximity tracking. And when we've looked at that, really given it a hard look, it requires everyone to do it. It requires reliable information on who's been near whom and when. It's unproven. You'll hear people saying, "Oh, that's what they did in Asia to control this." Not true.

What they did in Singapore and South Korea was the tried-and-true person-to-person contact tracing that public health does day in and day out. But we need to do this on a much larger basis. It's about supporting patients who have the infection and warning contacts who may have been exposed so we can close that box and prevent widespread transmission. It's not perfect, but it is one of our strongest tools. Otherwise, we'll all have to go back in again.

Whyte: While you were CDC director, you were always very big on communication and how we get the right messaging out. Things have changed a little since your tenure in terms of the number of voices that are out there. Often, the loudest voices are the ones with misinformation; we're having an infodemic.

So how do we make sure we get the right information to the American public? Because it can be confusing. Everyone who has a Twitter feed isn't necessarily an expert in infectious diseases or epidemiology. So that's a challenge we're facing at WebMD. How do we best educate folks? I'm interested in hearing your thoughts.

Frieden: The best place for definitive information on the coronavirus is That remains the most reliable source of information, guidance, and recommendations. And frankly, people are voting with their mouths and their fingers, with more than a billion clicks on the CDC website since this has started.

But also, we need to be hearing from CDC more regularly. I'm not sure why they're not being allowed to speak, but at least now we're seeing very important publications coming out of the CDC. The MMWR had half a dozen really seminal articles in the past week. And we're seeing CDC support states and localities throughout the US.

One thing that will be very important is to get local information about your community. What's happening in your hospitals? What's happening with spread to healthcare workers in your community? What are you doing to protect the nursing homes?

This is a terrible problem for nursing homes. Nearly 2 months ago, 6 weeks ago, I wrote that nursing homes are ground zero for the COVID pandemic. And we're seeing that. We've already seen thousands of deaths, and if we're not careful, we could see hundreds of thousands of deaths in nursing homes throughout the US.

Whyte: So, what do we need to be doing? What are we not doing with nursing homes that we could start today?

Frieden: Nursing homes need really extensive policies. They need to make sure that if anyone has symptoms, they're immediately isolated. They may need to make sure that no workers come to work ill. They need to make sure that if there is illness there, those individuals are rapidly cohorted. They need to have control measures and very vigorous cleaning of all surfaces that could be contaminated.

They need to reduce the number of visitors to only essential visits. They need to make sure that healthcare workers are caring for the same patients in the same groups of healthcare workers—what's called cohorting care. This is something that's been learned from Singapore and elsewhere, and it means that if you do have a cluster, it doesn't spread to the whole facility but just one wing or one part.

And maybe, just maybe, if immunity is confirmed and accurate antibody tests can be developed (because a lot of the ones on the market now are not accurate), we can have people who are immune caring for our most vulnerable people. They'll have jobs and our vulnerable people will be protected.

We have to figure out some way to try to cocoon the most vulnerable from this. The devastation it can cause should not be underestimated. The destruction that New York City is facing is unprecedented. It's been 100 years since there has been anything like this level of death in New York City from anything. In fact, if you look at the height of COVID and the height of the 1918 pandemic, this is certainly in the same range. It may even be worse week to week.

Whyte: You mentioned antibodies and antibody testing, which we're having challenges with in terms of accuracy—these point-of-care tests. Do you feel that antibody tests need to be done in the lab and we need to have a quantitative assessment of what type of antibodies one has, or do we just need better point-of-care tests?

Frieden: We need better tests. Whether they're point-of-care or laboratory, they need to be validated. We also need to understand what antibodies reflect. Do they actually reflect immunity or not? And that may take some time to figure out. And if they do reflect immunity, how long will that immunity last?

Whyte: What do you think is going to be the relationship going forward with public health and business? We've learned much more about how they're connected more than people typically would think. Are we going to come out of this with a stronger relationship and more support of public health, or do you think we'll just go back to how it has always been, that people will forget about it and move on?

Frieden: I certainly hope this is a lesson that we as a society and as a world will learn. Public health is the best buy. Most of our improvements in health come from public health, but we spend 40 times more on healthcare than we do on public health in this country.

Within the US and globally, we need strong public health systems so we can find threats when they first emerge, stop them promptly, and prevent them wherever possible. If we do that, we can prevent the next pandemic. It is inevitable that there will be another health threat that emerges. What's not inevitable is that we will continue to be so underprepared.

Whyte: Thank you, Dr Frieden.

Frieden: Thank you.

Whyte: And thank you for watching Coronavirus in Context. I'm Dr John Whyte.

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