As millions of people remain socially isolated and anxious about COVID-19, several U.S. governors are at least making plans to relax controls in their states and revive economic activity — against the advice of many public health professionals.
New York Times science and health reporter Donald G. McNeil Jr. warns that the push to reopen is premature. "We're nowhere near getting on top of this virus," he says.
McNeil has spent decades at the Times covering infectious diseases, including AIDS, Ebola, malaria, swine and bird flu, and SARS. He describes the ways that some Americans are approaching social distancing measures as a "giant garden party" compared with what the citizens of China and Italy have faced.
"I hear anecdotally that people [in the U.S.] are holding ... barbecues and people are still going out on Internet dates and having play dates with kids," he says. "Unfortunately, that's the reason that we have about 30,000 new infections a day in this country. ... China didn't reopen until they had zero new infections a day."
McNeil says even a fairly strict stay-at-home policy is "just the first step" in the battle against the pandemic: "There's a Harvard study that came out recently that said we should have 5 million to 10 million tests per day across [the U.S.] in order to have a clearer idea of where the virus is, where cases are going up. And cumulatively, all the tests we've done now has been 5 million."
McNeil points to China as a model of how to stop a fast-moving pandemic in its tracks, using widespread testing and a strict quarantine. "We're reluctant to follow China, but they did it," he says. "They did it brutally, but brilliantly."
On how testing worked in China
The model in China was, when it was time to be tested, you were taken to a fever clinic. You were screened in several ways: Your temperature was taken. You were given a quick flu test and a quick white blood cell count to make sure you didn't have a flu or bacterial pneumonia. And then you'd be given a quick CT scan. They could run as many as 200 CT scans a day on some of these portable machines so that they could check your lungs — because their tests had some time before the results came back too. And only after you cleared all those hurdles and you were definitely still a COVID case, then you got the test, because their tests were imperfect like ours are. And then you didn't go home to wait for the results of your test. You stayed there in the fever clinic, in the center. You were told to sit far apart from other people — 6 feet away from other people. And people sat there sort of scared with their envelopes with their CT scan results in their hands, waiting to hear if they were yes or no.
And then, if you were positive, you went straight into isolation — not back with your family but in one of these gymnasiums or armories, someplace like that, where you were in bed. There might be 100 people in a room.
On the idea that China's lockdown was overly strict
Chinese people love their families just as much as Americans love their families. They were initially reluctant to go into these quarantine shelters too. But when it became clear that it was saving the lives of their families. I mean, yes, some of them were forced in. Some of them were chucked into the back of ambulances by policemen. But that was not the norm. The norm was you were told, "Please come with us to the shelter. You will have food. You will have medical care. We will keep an eye out for you. And in three weeks, if you're good to go back home, we're going to test you, make sure you're OK, and then you can go back home." It's portrayed as brutal. But there are a lot of brutal things that the government in Beijing does. ... In this case, it was not brutal to its own citizens. It saved probably 10 million lives. That's how many I estimated would have died in China if this had just gone unchecked.
On what might happen if the U.S. reopens too quickly
If we all went back into baseball stadiums and churches and piled into grocery stores and got onto the subway, everything would be quiet for about two weeks, and then, whammo! You'd see temperatures go up on the Kinsa app, and then you'd see positive tests go up, and then you'd see hospital admissions go up. And then you'd see people being transferred into ICUs go up — and then you'd see deaths. We'd be on our way back to [previous predictions of] 1.6 to 2.2 million deaths [in the U.S. because of COVID-19] again.
So we have to go out very carefully, in little bits. And if we have enough testing to know how much virus there is around — that's what Tony Fauci [director of the National Institute of Allergy and Infectious Diseases] means when he says, "The virus will tell us." You'll see as the percentage of positive tests goes up — if you have millions of tests being done every day — you'll see, "Uh-oh. We have a problem here in southern Georgia," or "We have a problem here in the upper Michigan peninsula," or wherever we have a problem, and then you go back into hiding. You socially distance yourself as much as possible in that area. That can include anything from closing the schools again to keeping the universities open, because college students can socially distance, but kindergartners can't. You make choices, and you see how far you have to back off.
This is probably going to be a series of steps. We're going to have to do this again and again, dancing in and dancing out until we get to the point where we either have a vaccine or a prophylactic pill or some regimen — some curative regimen that's so good that we're confident that, if I get sick, maybe I get sick, but if I crash, I can count on being saved.
On how we don't yet know if people can become immune to COVID-19 — and how long that immunity would last
We do not know enough, and that's one of the big unsolved things ... because there are these anecdotal reports of people who seem to have been infected a second time. But you never know whether or not they had a false negative test that cleared them before that or whether or not there are some people who have kind of immune systems that are not perfect.
So it's very fuzzy where we are on this thing. But, as Fauci says, normally when you recover from a disease, especially if you've had a bad case of that disease, you have some period of immunity. With things like chickenpox and measles, it's lifelong. Even with flu, it usually lasts a year or two against that brand of flu — that mutation of H1N1 or whatever it is. So we would expect that there's protection, but we don't know what the antibody level is that confirms protection.
On a scenario in which people with immunity could have advantages
They would be the immune elite. There [would] be a whole new class of X-Men in this country. I mean, it's already happening. People who've recovered are very much in demand. We want your blood for the antibodies in it. And they [could], in theory, do the scary jobs, like intubating patients (if they're medical personnel), without fear. As more of them develop, they'll take my job or take yours, because they can go into the office and also they can fly on planes and go out to parties as long as everybody there is immune.
It [would] be a weird dystopian world of two classes: of the immunes and the vulnerables.
On the possibility that people would be tempted to infect themselves, hoping to achieve immunity
I am absolutely sure that will happen. I haven't found it, but I'm sure of that, because lots and lots of young people in this country are cooped up — out of work, frustrated. They're gonna see their friends outside having fun. ... And they're going to say, "What are my chances? One percent I end up dead? Three percent I end up in a hospital needing oxygen? Why don't I just get infected, take my chances and recover?"
On ways in which the pandemic might change our country for the better
This is like going through a war. And if we went through World War I and World War II, and after each of those wars, we tried to create the League of Nations, and we did create the United Nations. People saw that we were all in this together, and the attitudes changed after those wars. Unions were strengthened. Incomes became more level. People had had it with war profiteers, and taxes on the rich went up.
It led to the GI Bill and the Veterans Administration mortgages. In Europe, the widows' and orphans' pension funds led to the creation of the famous European social safety net. [They were] a very equalizing kind of events. And I'm hoping that something like that will happen in this country too, that we'll have kind of a rosy outcome from this and that people will value life more.
You heard it in Wuhan. People came out after two months in hiding, and they said, "My God, the flowers are so beautiful. I've never really noticed before." I think people will take more pleasure in the simple things in life and feel lucky that they got through this. So I'm hoping we have a brighter dawn, but we're going to go through some pain first. But then that's one of the reasons I stay relatively optimistic about this, because I can see maybe a better country emerging from this.
Amy Salit and Thea Chaloner produced and edited the audio of this interview. Bridget Bentz, Molly Seavy-Nesper and Deborah Franklin adapted it for the Web.
DAVE DAVIES, HOST:
This is FRESH AIR. I'm Dave Davies, in today for Terry Gross. As most of us remain socially isolated and anxious about the coronavirus, several governors are making plans to relax controls in their states and revive economic activity against the advice of many public health professionals. For some insight into the course the pandemic might take in the coming months and the prospects for a vaccine or effective treatment, we turn to Donald G. McNeil Jr. He's a science and health reporter whose bio in The New York Times says he focuses on plagues and pestilences.
He's covered AIDS, Ebola, malaria, swine and bird flu, SARS and other infectious diseases, and he's been talking to a wide range of experts about the future course of the coronavirus pandemic. Donald McNeil joined The Times in 1976 and has been a night rewrite man, an environmental reporter, a theater columnist and an editor. He was also a foreign correspondent in Africa and Europe and has reported from 60 countries. I spoke to him via Skype from my home in Philadelphia. He was at an apartment in New York City.
Well, Donald McNeil, welcome to FRESH AIR.
DONALD MCNEIL: Thank you very much.
DAVIES: Let's talk about where we are here. I mean, most of us find these restrictions we're living with - you know, staying home and leaving only to get food and medicine - pretty onerous. You have looked at what's happening here and measures in other countries. How likely are the restrictions that we have here - how likely are they to really smother this virus and drastically cut infections?
MCNEIL: Well, really smother? Not at all. I mean, our lockdown is a giant garden party compared to the lockdowns in China and even in Italy, and it's getting looser. I can even see that when I go out for a walk - which, if I were in Italy, I would not be allowed to do. But I go out for a walk to Central Park occasionally. And, you know, I can see plazas where there were zero people three weeks ago now have 20 people in them, lots people sitting around. I can see the traffic has probably tripled on the street. And, you know, those aren't all essential workers. These are people kind of ignoring the lockdown.
And, you know, I hear, anecdotally, that people are holding, you know, quiet garden parties or barbecues, and people are still going out on Internet dates and, you know, having play dates with kids. And unfortunately, that's the reason that we have about 30,000 new infections a day in this country. It's climbing a little bit, actually - above 30,000.
And, you know, China didn't reopen until they had zero new infections a day because that's when you've really gotten control of the virus and you know where it is, you know where your new cases are, and you can do contact tracing on, you know, a hundred new cases a day. You know, you can't do contract tracing on 30,000 new cases a day. If you assume that everybody has 45 contacts, which is about the average in Sichuan province, that's 1.3 million contacts you have to trace every day. So we're nowhere near getting on top of this virus right now.
DAVIES: So we're in a place now where most states have had some kind of stay-at-home order for weeks, and the president is leaving decisions on reopening to governors. And, you know, there are federal criteria, but the government isn't really enforcing it or taking charge. And some governors are determined to lift these restrictions, and I guess their best hope is that if we loosen, you know, the screws on these restrictions, the economy will gradually return, and infection rates will also gradually decline simultaneously. Do experts think this is likely, as we relax controls?
MCNEIL: No. If people - I mean, all sorts of things are not in place yet that need to be in place. I mean, we didn't go on lockdown just for fun, and lockdown itself is not how you meet the problem. The lockdown is just the first step.
So some places locked down that probably didn't need to because they didn't have much virus, but we didn't have enough testing out there to know where the virus was. I mean, we thought San Francisco and Seattle were going to get slammed, and they didn't. And we didn't really know that, you know, New York and New Orleans were going to get slammed, and they did in a huge way. And, you know, if you don't know it's in Sioux Falls, S.D., until people started dying, your surveillance system is not good enough. And that's the problem.
We - there's a Harvard study that came out recently that said we should have 5 million to 10 million tests per day across this country in order to have a clear idea of where the virus is and where cases are going up. And cumulatively, all the tests we've done now has been 5 million. So we are testing a tiny amount compared to other countries that are on top of this problem. We're really not responding to this in a rational way.
And the model is there. We're reluctant to follow China, but they did it, and they did it brutally but brilliantly. And they did something nobody else ever expected. It was like catching the wind. They stopped a fast-moving pandemic in its tracks - unheard of.
DAVIES: Well, let's talk about the testing issue here. You know, I mean, the health care delivery system in the United States is so decentralized. I mean, tests are given or denied by private providers and doctors' offices and hospitals and urgent care centers all over the place. And if we're going to have a plan for widespread testing and contact tracing, you know, somebody has to be planning this, right? I mean, assembling large groups of staff or volunteers and giving them equipment and training and organizing a strategy to do this - I mean, it's a big challenge, but it's not impossible. I mean, we do have a census every 10 years.
Is this happening anywhere? Is somebody taking this on? And is there any sense that, in two weeks or 10 weeks, that we'll have this kind of thing?
MCNEIL: I don't see it happening in a way that I can look at and say, wow, that's the model. I mean, the model in China was, when it was time to be tested, you were taken to a fever clinic. You were screened in several ways. Your temperature was taken. You were given a quick flu test and a quick white blood cell count to make sure you didn't have a flu or bacterial pneumonia. And then you'd be given a CAT scan, a quick CAT scan - they can run as many as 200 CAT scans a day on some of these portable machines - so that they could check your lungs because their tests had some time before the results came back, too.
And only after you kind of cleared all those hurdles and you were definitely still a COVID case, then you got the test because their tests were imperfect like ours are. And then you didn't go home to wait for results of your test; you stayed there in the fever clinic, in the center. You were told to sit, you know, far apart from other people, 6 feet away from other people. And people sat there sort of scared with their envelopes, with their CAT scan results in their hands, waiting to hear if they were yes or no.
And then if you were positive, you went straight into isolation - not back with your family, but in one of these gymnasiums or armories or someplace like that, where you were in beds - there might be 100 people in a room, you know, in a gymnasium, in beds 10 feet apart. And there would be nurses in the room in full PPE. And there were - you know, there were shelters for men, shelters for women and even shelters for kids. And so everybody was always under the eyes of a nurse. And there was oxygen tanks and CT scanners, if they had those.
But, you know, if you crashed - and that's a phenomenon of this disease - that you had the second-week crash, where you seem to be OK, you seem to be getting better and then suddenly - boom - your oxygen levels drop, and you're in serious trouble, and you may need to be hospitalized. And so they were able to keep eyeballs on everybody in order to say, hey, this one's crashing.
They even had these sort of dance classes led by the nurses, which sounds silly. And there's lots of Internet video of these dance classes. But really, what you're doing is getting sick people with pneumonia up out of bed. That helps clear the lungs of a patient. It also helps build up their upper bodies - their lower body strength. And they exercise. And that way you get some exercise into the patients, which is good, clears their lungs. And the ones who can't get up are the ones who are in trouble, and they need attention, and maybe they're crashing. And that's how we should be doing it. We do not want people going home and infecting the grandmothers.
DAVIES: Right. I mean, well, it seems like what China did is far more heavy-handed than anything we're likely to see in this country. But let me ask you - do you understand why we still...
MCNEIL: I don't agree with heavy-handed.
DAVIES: No? OK.
MCNEIL: I have a problem with this whole - you know, it's brutal. You know, Chinese people love their families just as much as Americans love their families. They were initially reluctant to go into these quarantine shelters, too. But when it became clear that it was saving the lives of their families - I mean, yes, some of them were forced in. Some of them were chucked into the back of ambulances by policemen. But that was not the norm.
The norm was you were told, please, come with us to the shelter. You will have food. You will have medical care. We will keep an eye out for you. And in three weeks, if you're good to go back home, you know, we'll test you and make sure you're OK. And then you can go back home. And, you know, it's portrayed as brutal. But, you know, there's a lot of brutal things that the government in Beijing does. But in this case, it was not brutal to its own citizens. It saved, probably, 10 million lives, you know? That's how many I have estimated would've died in China if this had just gone unchecked.
DAVIES: Donald McNeil is a science and health reporter for The New York Times. We will be back after this short break. This is FRESH AIR.
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DAVIES: This is FRESH AIR. And we're speaking with Donald G. McNeil, Jr. He's a veteran science and health reporter for The New York Times who's covered many infectious diseases, including AIDS, Ebola, swine flu, SARS and others. He's been writing about the course the coronavirus pandemic might take in the months or years to come.
Well, if we have a woefully inadequate structure for testing and inadequate plans for social isolation, what happens if we start seeing, you know, people going back to work, businesses reopening? What's going to be happening in that circumstance?
MCNEIL: Well, it all depends on, you know, this notion of the hammer and the dance. The hammer has come down - and actually, we have not done the hammer well enough. We should be down at close to zero new cases per day, but we're not. We're at 30,000-plus new cases per day. But were we to do it right, we would get as close to zero as we could. And then we would go out carefully and sort of see - if we all went back into baseball stadiums and churches and piled into grocery stores and got onto the subway, everything would be quiet for about two weeks. And then, whammo (ph), we'd be - you'd see temperatures go up on the Kinsa app.
And then you'd see positive tests go up. And then you'd see hospital admissions go up. And then you'd see people being transferred into ICUs go up. And then you'd see deaths go - we'd be on our way back to 1.6 to 2.2 million - whatever - deaths again. So we have to go out very carefully, in little bits. And if we have enough testing to know how much virus there is around, you can - you know, that's what Tony Fauci means when he says the virus will tell us.
You'll see, as positive - the percentage of positive tests goes up - if you have millions of tests being done every day, you'll see, uh oh, we have a problem here in southern Georgia. Or we have a problem here in the upper Michigan peninsula or wherever we have a problem. And then you go back into hiding. You socially distance yourself as much as possible in that area. And that can include anything from closing the schools again to, you know, keeping the universities open because, you know, college students can socially distance, but kindergartners can't. I mean, you make choices. And you see how far you have to back off.
And this is probably going to be a series of steps. We're going to have to do this again and again - dancing in, dancing out - until we get to the point where we either have a vaccine or a prophylactic pill or some regimen, you know, some curative regimen that's so good that we're confident that, you know, if I get sick, maybe I get sick. But if I crash, I can count on being saved. I mean, if we get to that point, maybe we can say, OK. We can all take chances now on getting sick and making ourselves immune by self-infecting - the equivalent of chickenpox parties. Maybe we could do that if we were sure we could save people. But we're not there yet.
DAVIES: Yeah. So would you see, like, half-measures? I mean, like, half-full subway cars or restaurants with people seating eight feet apart or kids going to school every other day - we're going to see things like that?
MCNEIL: Yes. And those things are all in practice in China right now even though the country has virtually zero cases. You go into a restaurant in China. You can go up to the counter and get some food. If you want to eat in the restaurant, you have - there has to be six feet between you and the person next to you and nobody in front of you - has to be six feet around at all times. And you have to wear a mask. And they have regular spray-downs with disinfectants. And they have extra ventilation coming through and lots of other measures.
And you also have an app on your phone that - in which the government lets, you know, you know whether it thinks you're healthy or not. So if you're immune because you've recovered, you've got a green light on your app. And if you're - also have not been any place where they know there's been a lot of exposure recently, then you have a green light. And you have to show that app in order to get into the subway, in order to walk into an office building, in order to, basically, do anything except go home and self-isolate. If you have a yellow or a red, you have to go into quarantine. It's very intrusive, but it's lifesaving.
DAVIES: Right. And that assumes that we can identify people who are immune because they have been infected. Is it clear now that if you've been infected that you are immune for some period of time?
MCNEIL: It is not clear. It is - we do not know enough. And that's one of the big unsolved things is we don't know if - because there are these anecdotal reports of people who seem to have been infected a second time. But you never know whether or not they had a false negative test that cleared them before that or whether or not - there are some people who have kind of immune systems that are not perfect. And they recover. But they don't completely suppress the virus and got a little virus replicating in them. They might turn up positive.
Also, it might be just that as lung cells die and clear themselves, you have some of the nucleic acids coming out. And those will make a test turn positive. So we're really - it's very fuzzy where we are on those things. But as Fauci says, normally, when you recover from a disease, especially if you've had a bad case of that disease, you have some period of immunity. And, you know, with things like chickenpox and measles, it's lifelong. With things like - even with flu, you know, it usually lasts a year or two against that brand of flu, that mutation of H1N1 or whatever it is. So we would expect that there's protection. But we don't know what the antibody level is that confirms protection.
DAVIES: If we are able to tell who's immune, that would make those people privileged and valuable, wouldn't it?
MCNEIL: Absolutely. They would be the immune elite. There'll be a whole new class of X-Men in this country. I mean, it's already happening. People who've recovered are very much in demand. They - you know, we want your blood. You know, we want your blood for the antibodies in it. And also, you know, they can, in theory, do the scary jobs, like intubating patients if they're medical personnel, you know, without fear. They can also, you know, as more of them develop, they'll take my job or take yours because they can, you know, go into the office. And also, they can fly on planes and go out to parties, as long as everybody there is immune. It's going to be a weird dystopian world of two classes, of the immunes and the vulnerables.
DAVIES: Do you see the government as being able to verify and then certify somebody is immune through - I don't know - would it be an ID pass? Would it be some kind of a digital marker on their mobile phone?
MCNEIL: Well, you can - I mean, I suppose you could put a chip under everybody's skin. But, you know, actually, this problem was solved by the adult film industry in California 10 years ago. I did an article about it.
MCNEIL: It used to be - I mean, it still is - if you want to act in a porn film in the San Fernando Valley, you have to have had an HIV and a syphilis and a gonorrhea test within the last 14 days. You have to have negative ones. And they - the actors could carry a picture of their negative test results through an app on their cellphone. And the producer, before he started shooting, would check the cellphones and then get on a password-protected website and check and make sure that they were, in fact, tested negative.
So, I mean, the software is there to do that. Whether or not we get organized enough, sure. It ought to be possible to make - put secure software on your cellphone that basically pops up a certificate that says I, Donald McNeil, am immune, and here's my picture, and here's my thumbprint that's attached to this immune thing so I can't hand this to my brother and he can go out - you know, go to my job or go to a party he wants to go to even though he's not immune. You know, you - in theory, there's no reason you can't do that.
MCNEIL: It just takes organization.
DAVIES: And what do we need to develop a clear understanding of immunity among those who have had the infection?
MCNEIL: You could do challenge trials, where you actually try to reinfect people again. But, more likely, is what we're going to find is - you know, I already know a doctor, for example, who's been infected and was quite sick for two weeks and then recovered, and he's back in his hospital. So if there are enough like him who do not get reinfected, just in and of itself, that's pretty good evidence. And one of the things you'd want to do is pull his blood and check his antibodies and see what the markers - what's called the correlates of immunity are. What does he got? Does he have IGG antibodies rather than just IGM antibodies? Does he have T cells and B cells, which are white blood cells that are programmed to produce the right kind of antibodies? You want to learn.
And I don't know if we're going to have to give blood test to everybody who's recovered. Probably, yes, in order to issue a real certificate of immunity, we may need to know that they've got a completely cranked-up and primed immune system that's ready to take on the virus. And it's not hard to do. It's possible. But it will require laboratory testing that actually looks at the white blood cells. It's not going to be something that you can do in a dipstick test, you know, like...
DAVIES: So would this create a circumstance in which some people are tempted to infect themselves in order to achieve immunity?
MCNEIL: I am absolutely sure that will happen. I mean - probably. I haven't found it, but I'm sure it's happened because look - lots and lots of young people in this country are cooped up, out of work, frustrated. They're going to see their friends outside having fun, you know, their friends who've recovered and taken their jobs. And they're going to say, look - what are my chances? One percent I end up dead, you know, 3% I end up on a - you know, in a hospital needing oxygen or something like that. Why don't I just get infected, take my chances and recover? And that may be one of our ways out of this lockdown.
I mean, I - this - it's possible that this would happen in the military. I mean, we now know from the - from, you know, the Theodore Roosevelt and from the Diamond Princess and other examples, where there are a lot of asymptomatic people. And, you know, if you could - you know, this is all very morally questionable. But you could actually say to the 82nd Airborne, you know, men and women, we've got, you know, a thousand of you. If you will get deliberately infected, we know that only, you know, 1% to 2% of you - because you're young and healthy - are going to crash, and we are now prepared with the ventilators and the Regeneron antibodies to save those of you who crash, and then the rest of you will be immune. And so now we've got another unit, another regiment of the 82nd Airborne ready to roll with, you know, with everybody else.
And so we may get to that point. We can't get to it in a completely disorganized, every-man-for-himself or every-teenager-for-himself kind of, you know, free-for-all of getting infected because then you're going to get - nobody will know how many people are out there. They're going to be home. They're going to be infecting their grandmothers, you know, and their parents. And some of them are going to have immune problems they didn't know they had. Some are going to be obese and have big problems. And some will die. If - I think the government needs to step in and say, we understand your need to do this, and we're going to let you do it in as safe a way as possible.
Now, this is all out-of-the-box thinking. But, you know, we haven't seen it - nobody who's less than 102 years old has seen a situation like this in America before, you know, that being 1918, 102 years ago.
DAVIES: Donald McNeil is a science and health reporter for The New York Times. He's covered a wide range of infectious diseases, including AIDS, Ebola, malaria, swine flu and SARS. We'll talk more about the potential course of the coronavirus pandemic after a short break. I'm Dave Davies, and this is FRESH AIR.
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DAVIES: This is FRESH AIR. I'm Dave Davies in for Terry Gross. We're speaking with Donald McNeil, a veteran science and health reporter for The New York Times who's covered many infectious diseases. He's been talking to a wide range of experts about the possible course of the coronavirus pandemic in the coming months and years.
When we left off, he was saying that over time, people who've had the virus and acquired immunity will be entitled to more freedom of movement and employment prospects than others, which might tempt some to infect themselves to gain immunity.
So is there precedent in previous epidemics for people to deliberately infect themselves or family members in order to get immunity?
MCNEIL: Absolutely, in the 1700s and 1800s. In fact, George Washington did it to his troops right after he took over the Continental Army. The British army practiced variolation, which was you would deliberately inoculate yourself with a small amount of smallpox from the pus of smallpox victim and you would then suffer a bout of smallpox, but it would usually be mild, skin-based smallpox. You had about 1% or 2% chance of dying. But if you instead were around during a smallpox epidemic, it killed about a third of the people who got it. So this was a common practice.
We lost the battle for Quebec partially because smallpox hit the American troops. Canada would be, you know, ruled from Washington today if we had won that battle, possibly. And it was smallpox that debilitated the army enough to make it lose that battle.
And so yeah, that was a thing back in the 1700s. But in the modern age of vaccines, no, we don't normally do that. There are chicken pox parties for people who don't believe in vaccines and want to get infected that way. And I never thought those were a good idea since there was a chicken pox vaccine that was pretty good, but it was done.
DAVIES: So this really changes if we get a vaccine. I've heard estimates that - you know, I think Dr. Fauci said don't look for it for 18 months or so. What do you hear from experts about how long this could take?
MCNEIL: They say a year to 18 months, which is what he said was very optimistic. The record for creating a vaccine in this country is four years. The mumps vaccine was made in four years by Maurice Hilleman back in the 1950s. Now, we've got faster ways of making candidate vaccines through DNA and RNA splicing. That part has really changed a lot.
The problem is you still have to do the testing. And there's a phenomenon, particularly with coronaviruses, where you have a danger called antibody-mediated enhancement, or an antibody-dependent enhancement, which means that occasionally people have tried to make vaccines against coronaviruses - 'cause there are a number of veterinary vaccines and there are also - there have been attempts to make a SARS vaccine. The vaccine makes the problem worse. It makes you more likely to catch the disease rather than less likely, and that's a disaster. And you have to make sure that your vaccine does not do that. And for some reason, coronaviruses are inclined to do that. So we could have a vaccine that ends up being a dead end. I mean, when...
DAVIES: Or harmful, right?
MCNEIL: Or harmful. Yeah. Well, I mean, you have to - if you realize it's happening - if you do it in lab animals and you get an antibody-dependent enhancement, you have to stop right away. Somebody who I know who was making a SARS vaccine had that. The mice, suddenly, their lungs filled up with fluid. And he realized, oh, my God, this is a disaster - and stopped. You don't want to get the human testing with a vaccine like that. You want to find it out on animals first.
But sometimes that kind of problem doesn't show up unless you do a lot of tests. So I mean, there are ways we can speed up the development of a vaccine. One that's really ethically dicey would be to do challenge trials. And that means - first, you do the regular safety trials in about a hundred people, and you look to see if they get antibodies. And then, normally, you would increase the size of your pool of volunteers up into the thousands. And you'd probably go for first responders because they're the ones who are in the path of the virus. And you give half of them the vaccine and half of them a placebo and you'd see if the vaccine protected. That takes a lot of people and a lot of time because you're sort of waiting for natural infections to take place.
The other way to do is through challenge trials, which is to give people a vaccine. You wait a couple of weeks till they develop antibodies, and then you deliberately infect them with the virus to see if it protects them. Now, that is normally totally unethical except in diseases like malaria or typhoid fever, where you can completely cure them with malaria drugs or antibiotics. We don't have a cure for this drug. So you're putting people - theoretically, you're putting people in mortal danger.
But overall - I mean, people argue that we're going to have to go to challenge trials because it's not safe to have millions of Americans at risk of this virus. It's ethically better to put, you know, a few hundred Americans at risk of a challenge trial than it is to leave millions of Americans at risk of this virus. So we're going to make some ethical and moral choices in vaccine development that we don't normally make.
And you know, the Chinese will be making them, too, and other vaccine-makers will be making them, too, because it's going to be a race for a vaccine because the first person to have the vaccine is, you know, potentially going to be quite a dominant nation in the world. And that's not necessarily going to be us 'cause one of the big problems with coming up with a vaccine is we also have to make 300 million doses. Or if we need two shots, we're going to have to make 600 million doses.
And the typical vaccine plant turns out about 4 to 10 million doses a year because there's 4 million babies born each year and there's 4 million people turn 65 each year in this country, and that's your target market. So somehow, we're going to have to find a way to make a lot more vaccine doses than we normally do.
DAVIES: And so what are the challenges with that? I mean, you know, a lot of manufacturing operations are designed to scale up quickly. What's the challenge in generating a lot of doses of a vaccine?
MCNEIL: Well, first of all, you have to - it has to be produced in totally sterile conditions 'cause you're going to be injecting it into the people. So it's not - I mean, I did have an expert tell me, you know, we could maybe convert breweries or distilleries with their large - I mean, it's essentially - it's you put the vaccine into a virus and the virus then goes into a giant soup of cells - which may be monkey kidney cells or army worm cells or Chinese hamster ovary cells - and it grows in those. And then you drain that all out and you purify it, and you get rid of all the cells, and you have the vaccine proteins that you're going to inject into people.
You know, these are pretty high tech kind of labs - kind of factories. And so they have to meet very high regulatory standards because you going to be injecting it into old people and children and a lot of others. So you know, you - we need to start building those things right now or converting other plants to do that. And that may mean that we stop making measles vaccine and we stop making pneumococcal vaccine and we start making a lot of other vaccines we make so we end up putting people in danger of, you know, not being able to get a shingles shot or not being able to get hepatitis A or B shot or something like that while we're converting everything to a COVID-19 vaccine. So a lot of tough moral choices in cases like this.
Or we may go to one other country and say, hey, would you be willing to make vaccine for us? You know, India has a big vaccine industry. Brazil has a big vaccine industry. I worry that the virus is going to blow through those countries so fast that they're going to achieve herd immunity through deaths, you know, and they may not need a lot of their spare vaccine capacity.
The other country that has a big vaccine industry is China. And China, as long as it holds its epidemic under control as well as it has, you know, could come to us and say - yes, we'll make vaccine for you, you know, in the interest of being nice and in international cooperation, it might say we'll make it for you at cost. But they might also say, we'll make it for you at $1,000 a dose. Or they might say - you know, I mean, I think about things like - Donald Trump has spent the last year insulting China and calling it the Chinese virus and saying things that promote attacks on Chinese Americans. And Xi Jinping may have finally had it. I don't think Donald Trump's policy of insulting China is a very smart policy either for this country or for himself. And I really wish he'd stop.
DAVIES: So it sounds as if it could easily be two to three years before we have a vaccine. For those of us who are dealing with social isolation - and kind of the scenario you paint is one in which, you know, the controls get relaxed and then infections increase and then controls get reimposed. For those who are not immune, it could mean working at home or working through this stuff for a really long time, couldn't it?
MCNEIL: Yes. And you know, I have a granddaughter who is due to be born in June. And I have had to get myself used to the idea that I might not actually be able to hold her for two years until I'm unvaccinated, you know? I suspect I could meet my daughter in the park and see my granddaughter from 6 feet-plus away. But I'm not going to able to pick her up or anything - I mean, not ethically - not, you know, without doing something I shouldn't be doing. And I'm not the only person in that situation in this country. And it's very - it causes a sense of despair. I mean, I'm mentally prepared for it, you know, because I see the need. But I think a lot of people are going to be terribly despairing when they realize that, you know, the rosy picture that the White House has painted of we're all going to be watching the Packers play the Lions in the fall is not what's going to happen.
DAVIES: Donald McNeil is a science and health reporter for The New York Times. We will continue our conversation after a short break. This is FRESH AIR.
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DAVIES: This is FRESH AIR, and we're speaking with Donald McNeil. He's a veteran science and health reporter for The New York Times who's covered many infectious diseases, including AIDS, Ebola, swine flu and others. He's been writing about the course the coronavirus pandemic might take in the months or years to come.
President Trump has condemned the World Health Organization and put a hold on its funding from the United States because he said it was biased towards China, accepted China's claims that the virus wasn't transmitted among people for too long. You looked into this. How do you rate the World Health Organization's performance here?
MCNEIL: I have been following the World Health Organization for 20 years. And believe it or not, I consider this the World Health Organization's finest hour. You know, during the whole time Margaret Chan, the former director-general was in charge, she went to West Africa to look into the Ebola epidemic months late. They were really slow responding to that outbreak in West Africa, and she only went once.
Tedros, the new guy, has completely refocused the WHO not on tobacco, as Michael Bloomberg wanted with his donations; not on polio, as Bill Gates wanted with his donations; not on the rights of the pharmaceutical companies, as the United States wants with its donations - he has focused it on fighting pandemics - on response. They have been warning since January 22 that this is a dangerous virus; the world has got to react. Never mind when they declared it a pandemic - that's not important. What the WHO does is it declares public health emergencies of international concern.
And it met on January 23 and debated whether or not to do that. It doesn't do it by itself. It has an expert panel. The panel said, no, it's an emergency in China, but it's not international yet. And that was correct. On that day, that was correct. There were very few cases any place else except in China. One week later, when it became very clear that it was spreading to other countries, they called that panel back again and they declared a public health emergency of international concern. That's the alarm bell.
So that was January 30. They have been ringing the alarm bell as loud as they know how to ring it since January 30, and I have been listening to those press conferences. Every single day, Tedros would hold a press conference and say, this is a dangerous virus - do not underestimate it; you know, you've got to prepare. It is possible to contain it, but you have to act now. There is a window of opportunity, and that window is closing. And I heard him say that again and again and again, and no one would pay attention.
I got the story into The New York Times on February 2, saying this is going to be pandemic. You know, a few people read it in The New York Times, but nobody in Washington paid attention. The Red Dawn emails that my colleague Eric Lipton came out with showed that a big debate was going on at the very top levels of the Trump administration among the national security people saying this is bad. This is, you know, a major, major threat; it's like 1918 all over again, and we have to pay attention to it. Why is nobody (unintelligible)? And instead, Donald Trump was just saying it's all going to go away; it's going to disappear by April. It's - we've only got five cases, and they're going to disappear. There was an absolute shut down.
So the WHO performed admirably. What happened in China - people don't really understand this. The cover-up was not, as far as I can tell, by Beijing. The cover-up was by the mayor of Wuhan. The small alarms were rung on December 30. We knew about it. I knew about it on December 30. There was a thing on ProMED - this is a disease alert service - but it was very unclear. It was 27 cases of an unknown pneumonia related to a seafood market. And they put out a request for information. The WHO knew about it; the Canadians knew about it. And then there was the clampdown, and that's when that doctor was told to shut up. That's when other doctors were threatened with arrest. And that's when the local authorities started to say, no, no, there's no human-to-human transmission.
Beijing sent a team down to Wuhan to figure out what the hell was going on after a week or so. And it took that team, partially, I think, because that market had been closed down and all those people who were coming to the hospitals near the market were now scattered around the city. It took them until the 17 and 18 and 19 to figure out that, yes, there was absolutely human-to-human transmission and, yes, doctors were getting this disease and they were dying of it. And on January 20, a doctor named Zhong Nanshan, who's like the Tony Fauci of China, got on national TV and said the mayor of Wuhan - he didn't say the mayor. But he said Wuhan has not been telling the truth. This is transmitting human to human. Doctors are dying. The whole country should stay away from Wuhan. It's very dangerous.
And three days later, Beijing came down on Wuhan like a ton of bricks. They had their heel on the neck of the mayor. He was forced to apologize on national television. They shut down Wuhan. And they told the WHO immediately what was going on. So I contend that this was a local - it was as if Chicago was lying to Washington.
DAVIES: What about the complaint that China refused to let a WHO medical team into the country to investigate for about three weeks?
MCNEIL: Well, they delayed for about three weeks. They were trying to get a hold of things. There was a lot of controversy. I mean, you know, the CDC was demanding to go in. And they let in a WHO team, and that WHO team did have somebody from the American CDC on it, and it did have somebody from the American NIH on it. Not letting in a CDC team - my feeling is, if I were China, you know, the CDC took an arrogant attitude that - we'll come over and, you know, give them some pointers. The Chinese - it's like, wait a minute, you know. We've got this. We've gone to some of the top universities in your country, medical schools in your country. And we've also had people who work for the CDC now cooperating with us. We don't really need your help.
And also, the CDC, the American CDC, unfortunately, is famous for taking samples away from foreign scientists, analyzing them and then publishing them in its own journals. And if you're a Chinese scientist, if you get an article in The New England Journal of Medicine or The Lancet - you're the lead author - you get a prize of $100,000 from the Chinese government. And so nobody wants to give up their samples.
In fact, a big problem, Ian Lipkin told me, is that the Chinese scientists are not cooperating with each other. They're hogging their samples and their data - or they were - until they can publish. Then once they publish it and they earn the hundred thousand bucks, then they - so scientists are not complaining that there's no data from China. Scientists say, hey, we've got what we need. And besides, we've got our own samples here. So this is really a Trump administration lie. It's not something that scientists, real scientists, are complaining about. They don't feel that China has been withholding anything important.
DAVIES: If it takes us years to get through this, are there any ways that it might change the country for the better?
MCNEIL: Yes. I hope that a lot of things will change for the better. I mean, this is like going through a war. And if - we went through World War I and World War II and after each of those wars, you know, we tried to create the League of Nations, and we did create the United Nations. And, you know, people saw that we were all in this together, and they - the attitudes changed after those wars. I mean, unions were strengthened. Incomes became more level. People had had it with war profiteers. And, you know, taxes on the rich went up. You know, it led to, you know, the GI Bill and the Veterans Administration mortgages. In Europe, the widows and orphans pension funds led to the creation of the famous European social safety net.
So there were a lot of - you know, it was a very equalizing kind of event. And I'm hoping that something like that will happen in this country, too, that we'll have kind of a rosy outcome from this and that people will value life more, that people will - you know, you heard it in Wuhan. People came out after two months in hiding, and they said, my God, the flowers are so beautiful. I've never really noticed before. And I think people will take more pleasure in the simple things in life and feel lucky that they got through this.
So I'm hoping we have a brighter dawn, but we're going to go through some pain first. And - but then that's one of the reasons I stay, you know, relatively optimistic about this - because I can see maybe a better country emerging from this.
DAVIES: Donald McNeil, it's been interesting. Thanks so much for speaking with us.
MCNEIL: Thank you for inviting me.
DAVIES: Donald McNeil is a science and health reporter for The New York Times who's covered a wide range of infectious diseases. Coming up, John Powers reviews the new TV series "Normal People," which debuts this week on Hulu. This is FRESH AIR.
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