Dr. Angela Rasmussen: Keeping opinions out of COVID-19 policy will help
Leading US virologist Dr. Angela Rasmussen demystifies COVID-19 and says US efforts to limit the pandemic have been hurt by politicization, and because people have opinions ‘not based on science.’
By FELICE FRIEDSON/THE MEDIA LINEA LAB technician works on investigational coronavirus disease treatment drug Remdesivir at Eva Pharma Facility in Cairo, Egypt, in June(photo credit: AMR ABDALLAH DALSH / REUTERS)
Renowned virologist Dr. Angela Rasmussen focuses on pathological emerging viruses that cause severe disease such as Ebola, influenza, SARS-CoV-2 and COVID-19.She earned her master’s degree and doctorate in microbiology from Columbia University and is currently an associate researcher at Columbia Mailman School of Public Health.Rasmussen delves into the severity of COVID-19 as she seeks to understand how the disease went out of control and why. She feels messaging to the public has gone off rail, bearing in mind the problems in terms of health and economy.The Media Line’s Felice Friedson discusses with Rasmussen the rush to create vaccines and the need for proper clinical trials. Rasmussen points to the new drugs’ safety and effectiveness, believing that a vaccine that is rolled out but is not protective is far more dangerous. She opines that while a preliminary vaccine would buy time until a better one is developed, safety is critical in vaccines being developed for human consumption.The two women also discuss reinfestation and speak about fact versus myth in terms of paths of transmission of the disease and reinfestation of the virus and about concerns when traveling.Friedson explores women in stem cell research and the lack of exposure facing women in scientific fields.When COVID-19 came on the scene, the common thought was that COVID-19 was new and unknown, but you were one of the few people for whom it was neither new nor unknown. What was your reaction when you learned COVID-19 was being identified?Angela Rasmussen: Initially my reaction was kind of wait and see, but we have seen other coronaviruses emerge, most notably in 2003, SARS coronavirus or “SARS Classic” as I call it. And in 2011, MERS coronavirus emerged as well. It’s not unexpected to have a novel coronavirus emerge, especially from East Asia where we know that a lot of these viruses are normally circulating in wildlife.What I didn’t know, and what we kind of had to wait and see, was how serious it would get. Is this something that, like SARS Classic or MERS coronavirus, could be relatively contained, or is it something that would spread out as it has actually unfortunately done? So it wasn’t terribly surprising. What is surprising is really how out of control this pandemic has gotten, and that largely doesn’t have anything to do with the virus. It has to do a lot more with the policies that were put into place in response to it.You bring this up and it’s a very important issue. You’ve been in public in stating wearing a mask in public is absolutely necessary. Yet many are relaxing such measures, and as we speak, Florida and Texas are among states digressing in the fight to stop the outbreak. What are you suggesting?Masks are actually a great example of how the messaging for this has really gone off the rails.Initially, I was a little concerned about mandatory mask guidance, just because I was worried that people might think that masks, whether made of cloth or surgical masks, are protective for themselves. And it turns out that, well, that’s not the case. The benefit of masks is really for what we call source control, in preventing people wearing the mask from dispersing respiratory droplets, adding to the environment and exposing other people.Now the mask is seen as kind of gone completely the opposite direction in that, you know, some people don’t believe that masks are necessary or that they do anything and that they shouldn’t be worn.In general, I think that we’ve seen other countries really successfully control community transmission of this virus by implementing masks as well as other measures. So encouraging mask use; running effective test, trace and isolate epidemiology approaches; and practicing physical distance, minimizing crowds and encouraging good hand-sanitizing – all of those things together have allowed some other countries, such as Singapore, Taiwan, South Korea, and many places throughout Europe, to really effectively control community transmission and keep it at much lower levels.So, my recommendation is that we need to be applying all of those things. And in some states here in the US where cases are increasing dramatically, we should consider reinstituting stay-home orders, although I’m not sure how effective that will be at this point, considering much of this has been really politicized and people have a lot of opinions that are really not based on science and evidence of what we know about this virus. So, I’m very worried, but I think that the things that people can do is to stay home if they can, to always wear masks in public spaces, just out of being a good, concerned citizen and showing respect and care for your fellow human beings. And then being very conscious about socially distancing, avoiding long durations in closed spaces with a lot of other people. I think that at least if people made an effort to take up some of those measures, we would be able to start reducing community transmission, at least, even if we aren’t able to control it as well as some other countries have done.Do you think people are not taking this pandemic seriously? Or are they exhausted by the safety routines?I think both of those things are true. I think there are some people who are what I’ve called the COVID-19 truthers or denialists, who actively oppose any evidence that it is a serious, potentially lethal disease and [believe] that it’s not very serious and it’s similar to the seasonal flu, and we couldn’t really be worried about it. There are certainly a number of people who seem to believe pretty strongly in those ideas, even though they’re not based in any kind of evidence whatsoever.But I think a lot of people are, as you said, exhausted with quarantines and staying home and not being able to go out and function as a normal society. And I think a lot of people are also in a position where they really don’t have much of a choice, because of the financial hardships that have been imposed by the public health measures that were taken.Unfortunately, here in the US, insufficient support was provided from the government for many people who really need to be out there working who don’t have the financial means to stay home or work from home indefinitely.So, I think that both of those things are going on. And then in some cases, people just really don’t have a choice. They have to get back to normal or they won’t be able to feed their families or, you know, keep a roof over their heads. So, it’s a really, really difficult situation. And a lot of different factors are sort of motivating this, at least with the American people.Please help debunk some of the myths the public is hearing about every possible way to contract the virus, and where hundreds of companies and labs globally are working around the clock to come up with better testing methods. How can the public know what to trust?There are so many unknowns about this virus still, and I think it seems like it’s been a million years since January or February, when this kind of came on everybody’s radar, but it’s only been six months. And we don’t actually know that much about this virus. There’s still a lot of things, [as] you just pointed out, that are active areas of research.I try to focus on the things that we do now. We do know that this virus is largely transmitted [by], or at least the major driver of transmission is, respiratory droplets for presymptomatic people, people who don’t know that they’re sick yet.That is one of the things that make this virus so difficult to control, because I think most people are not going to intentionally expose others, if they think that they’re sick, or if they have symptoms. But if you don’t know that you’re sick or that you’ve been exposed, you won’t know to take precautions, to avoid infecting other people.There have been a lot of concerns, as you mentioned, [about] the different routes of transmission. And there’s a lot that we don’t know about that, but it does seem like the primary, major driver of transmission is what we call respiratory droplets. And these are the small droplets of saliva that you produce every time you breathe or speak.Some of those are very, very small and can stay in the air for long periods of time. And that’s what’s referred to usually as aerosol transmission. We think that aerosol transmission may occur, but it’s not the major driver.The major drivers are these larger respiratory droplets that are produced when you’re either yelling or singing or coughing. And those can largely be prevented by social distancing, staying outdoors, and by wearing a mask. All of those three things are different risk-reduction techniques. And it does seem that we know enough to say that that won’t completely eliminate the risk of transmission, but it will significantly reduce it.So, the real challenge is getting everybody on board with that. And that is, I’m not sure that that’s a talent we’ll be able to actually accomplish, given that there has been so much confusing messaging about this, and people are just really losing their appetite for being in this pandemic, which really is a marathon and not a sprint.Dr. Anthony Fauci had claimed that a vaccine might be ready as early as 2020. There is no time for proper clinical trials. So, what is the downside?There are a number of downsides to putting out a vaccine that is not safe or that is not effective. So, obviously, not safe – I think everybody can understand that. If the vaccine makes you sick itself, that’s probably not a very effective vaccine, because the point of vaccines is to provide immunity without you getting sick. So, if there are any safety issues or a large, high rate of adverse events associated with death [in] getting the vaccine, it’s really important that we don’t use that vaccine and use one of the other hundreds of candidates in the pipeline right now.The other issue, though, is efficacy, and this has been very confusing, I think, for people to understand.Even if we have a vaccine that is only partially effective, meaning it only works in some people, or it doesn’t provide what we call sterilizing immunity, meaning that it prevents you from getting infected, but it might reduce disease, even something like that would be helpful.But if we have a vaccine that doesn’t work at all, that can actually be extremely harmful if rolled out at population scale, because you end up wasting a lot of time and resources manufacturing that to give to everybody, and then you give it to everybody, and if it’s not protective, those people will think that they’re protected and may engage in behavior that would be higher-risk, and be potentially more exposed to a situation [where] they might get infected.So, it’s really important to make sure that any vaccine at least works partially, and we have a good example of vaccines that do provide partial but not complete protection. Every year the influenza vaccine is really a best guess of the influenza strains that will be circulating. And sometimes it doesn’t provide complete, sterilizing protection against those. You might still be infected with flu, but it’s thought that even that partial protection makes your disease less severe. And for something like SARS-coronavirus 2, that could make a huge difference.We already know that most people who get this virus don’t develop severe disease, at least severe acute disease, but we could reduce the number of people who are getting that, that minority of people who are getting really, really sick. That would actually save a lot of lives. And since this virus is pandemic, most of the population of the world still hasn’t been exposed. That means that most of us are still susceptible. So, if you could get a vaccine out that provided even some partial protection and reduced hospitalizations, that would at least buy us time to develop another vaccine that might be more effective and provide... protection over a longer period of time.So, I think the real question now – and this is the real challenge for vaccine development – is how do you determine if the vaccines in clinical trials now are effective?The only way to do that, really, is what takes so long. You have to vaccinate a lot of people with the experimental vaccine and then follow them and wait for them to be exposed to the virus in the normal course of their lives. And again, even though it seems like coronavirus is everywhere, it is a small number of people overall in the population that actually have it. So, people who are in this trial are not necessarily going to be immediately exposed to coronavirus. So, it takes a long time to follow enough of those trials subjects so that they will be exposed so that you can make a comparison with a control group and actually determine that there is statistically significant protection for the people who received the experimental vaccine. This normally takes years.You reside in New York, but you’re not there currently. Are you comfortable flying commercial airlines at this time?You know, I am while wearing a mask, and I do have an N95 mask that I could wear on a plane.That is also why I haven’t gone back to New York. My husband normally lives in Seattle, so I traveled back and forth quite frequently prior to the pandemic, and I’ve been here since March because I didn’t feel that it was the responsible thing for me, as a professor of a public health school, to do, to get on a plane and fly from one (at the time) coronavirus hot spot in Seattle to New York, which was a growing coronavirus hot spot at that point. Now neither Seattle nor New York are coronavirus hot spots.I think that it would be relatively safe, or as safe is as, you know, getting into a small enclosed space for six hours can be, which is not completely safe, but I could minimize my risk by just being very diligent about mask-wearing, hand-sanitizing and so forth.But I still am a little concerned about practicing what I preach. Columbia University, first of all, has said that if you don’t need to work in person in the lab, you shouldn’t do that. So I’m continuing to follow that advice and continuing to work remotely until I absolutely have to be back.And so, if there were something that I needed to do in the lab, I would certainly go, and it’s really important, of course, for people like me with those types of skills to contribute if it’s needed. But my center does have a lot of other people who are qualified to do that type of work, and who are doing it. And my technician is currently in New York, doing all the lab work for me.So, I do the normal stuff that I usually do, which is write papers and grants, and these days give interviews. But unless I’m absolutely needed for critical public health responses, I think I might as well just continue to reduce any risks to others like [by] continuing to stay home as much as possible and not travel by air again, unless it’s absolutely necessary.Flying is on everyone’s mind. It’s summertime. People are going to miss their summer vacations, and we’re talking in droves this year. But if you get on a plane, and you wear even a N95 mask, and you take that off and you eat a meal – and you talked about the respiratory droplets flowing and in a very enclosed area – how can that be safe?People have done studies at least with influenza transmission on airplanes. And it actually, it doesn’t seem like if you were sitting in the back of the plane and somebody in the front of the plane has influenza, you can get it.That said, people have been infected, it seems, from somebody walking down the aisle or lingering in the aisle. So a lot of it really depends on how full the plane is, or what the dynamics of the passengers on that plane are doing.If you’re wearing an N95 mask, then you are pretty protected, 95% protected; that’s actually what the 95 in N95 stands for. So you would be pretty safe, as long as you didn’t take that off. If you took it off, your risk would increase.But, again, it will depend a lot on the behavior of the people around you. Most of the people who’ve gotten infected on these planes, in these influenza studies that I just mentioned, were sitting immediately near that [infected] person. They were either in the same row, or they were a row directly in front or behind them. Even though planes do use recirculated air, it’s filtered, so these larger respiratory droplets do not linger in the air for long periods of time. So, again, you’re probably protected from people who are far away from you on the plane. You’re just not protected from people who are in a very close proximity to you on the plane. And it’s very difficult to socially distance on a plane, especially if the plane is at capacity or if it’s full. With some planes, you know, we’ve seen reports of some airlines still filling up planes.You know, it’s always going to be an increased risk when you fly. And I would recommend that people rethink their summer vacations to take vacations that might not require air travel – something that you could drive to – or even just have a staycation, even though I think probably most people are dying to get out of their houses right now. But I would not fly unless it was absolutely critically necessary.
