By Katharine Webster
Photo by Edwin Aguirre
PROF. SUSANNA REMOLD SERVED WITH WHITE HOUSE PANDEMIC WORKING GROUP
From 2017 to 2018, Remold represented the National Science Foundation on a multiagency presidential task force to advance research, technology and practices that improve prediction of infectious disease outbreaks and minimize their effects. Officially known as the Pandemic Prediction and Forecasting Science and Technology Working Group, it was set up in 2013 within the White House Office of Science and Technology Policy, but was effectively dissolved in 2018.
Remold says that now more than ever, policymakers and the general public need to listen to instructions from those who have spent their lives studying pandemics – both the biology and epidemiology of such diseases and the best policies for containing them.
Recently, she sat down to explain how such diseases evolve and what we should be doing to respond to COVID-19.
Q: What should people be doing right now in response to COVID-19?
A: Everybody should be staying home.
Here in the U.S., we are not responding quickly enough to this crisis. We are not taking strong enough action, and when we do, we are days or weeks too late. The dramatic shutdown of Hubei Province in China worked – and if they’d shut things down a day or two earlier, it could have saved many thousands more people from getting sick.
Q: Some people still think stay-at-home orders are too drastic – even policymakers who are getting expert advice. Why is that?
A: I think it’s because we tend to respond based on our experience. But if we do that in this case, we will under-react.
The rate of increase in infections and deaths grows exponentially, not steadily, so the increase we experienced between yesterday and today is MUCH less than the increase between today and tomorrow.
How should we meet the crisis? First, we should look ahead at regions that had similar numbers of cases to Massachusetts, but had those numbers a week earlier – and realize that those regions are now much worse off than we are here in Massachusetts. Then, we should respond as if it is already that bad here.
That is the only way we can get ahead of this virus. And whatever we do, we should do on a large geographic scale.
Q: Other countries have had success with less drastic measures. Why won’t they work here?
A: You can intervene early with relatively cheap measures. The later you respond, the more costly it is in terms of lives and the economy.
Widespread testing and contact tracking are key to controlling the pandemic with the least amount of economic impact, because then we can target further testing and quarantines to those who have been exposed and also make good decisions about which people are able to move around safely. Some East Asian countries like Japan, Thailand and Singapore that used this approach have seen slower rates of increase than we have in the U.S.
Unfortunately, we missed that opportunity, and so we don’t know when and where many people became infected. That’s why we need to be serious about social distancing. If we can’t test people with mild symptoms or no symptoms and determine whether they have it and might have given it to anybody else, then everybody needs to stay home.
That means don’t even go to the supermarket: Plan ahead and get your groceries delivered. Don’t go anywhere else unless you absolutely have to. That not only protects you, but it helps to protect health care professionals and other essential workers from getting COVID-19.
Q: What insights into pandemics have you gained from your research into the ecology and evolution of organisms that change hosts?
A: If you think about the World Health Organization’s six stages for a pathogen to become a pandemic and about how human interactions with their environments have changed, you can understand why we are seeing more potential pandemics.
We are coming into contact with potential animal hosts and with one another more frequently. That’s partly because large populations of humans are living much more closely to wild hosts than they used to and encroaching on wildlife habitats.
Changes in how we raise and care for animals also matter. Some of these changes are economically driven, like more intensive livestock farming, while others are linked to climate change. A good example is MERS, which is caused by another coronavirus that first moved from camels to humans in 2012. People have always raised camels for meat and milk, but changes in the availability of water and forage due to climate change are causing people to favor them over other livestock more and more. As a result, opportunities for transmission of MERS from camels to humans are on the rise.
The second huge change is modern travel. In the U.S. and many other places, people are now mobile across large geographic areas and frequently travel internationally. This means we have much less time to react when a dangerous shift of a pathogen into humans occurs.
So economics, politics and social customs, and how they change when population density and livestock density increase, all play a role.
Q: Do you have any other advice on how we can get better at dealing with this pandemic and prepare for future pandemics?
A: The task force demonstrated the power of people with vastly different backgrounds working together to address a critical threat. It included experts in epidemiology, ecology, entomology, agriculture, meteorology, social science, economics, mathematical modeling and policymaking, as well as representatives of the military.
Once a disease shows the potential for community-level outbreaks and we know an epidemic is imminent, we should pay more attention to social, behavioral and economic scientists on how to prevent a full-scale pandemic. They have expertise on policy questions that is vastly under-appreciated.