Julio Frenk, Mexico’s former Minister of Health, has lived through four pandemics, but the new coronavirus outbreak has been the most challenging of all, he said.
“The next time around we may have the combination of something very contagious and much more lethal,” Frenk told Newsweek. “We can’t just be playing this Russian roulette with the future of humanity.”
An outbreak of a new coronavirus, officially named SARS-CoV-2, was declared a pandemic on March 11 and has infected more than 766,000 people across the world. The United States has more than 164,000 cases and officials said the peak of the outbreak is still around the corner.
Frenk told Newsweek that “uncertainty” is the essential characteristic of the emergence of any novel pathogen. Every experience is unique, he said, and yes, you can learn from each pandemic. But in this case, there are two characteristics that make it particularly challenging.
“One is that it is very contagious and the second is that people who have no symptoms or very mild symptoms can transmit the disease,” Frenk said. “This is what makes this one the most challenging of the three prior pandemics I’ve been involved with.”
During the severe acute respiratory syndrome, or SARS, outbreak, Frenk was Mexico’s minister of health. While the two viruses share commonalities and SARS has been used as a reference point in discussions about the new coronavirus, there’s a major difference between them, he explained. Unlike the new coronavirus, Frenk noted that SARS could only be transmitted by people who were sick and usually those people were already in a hospital.
“They’re already contained,” Frenk, now the president of the University of Miami, said. “Whereas with this current coronavirus, healthy people who feel okay and don’t have symptoms or have mild symptoms can be out there spreading it. That’s the challenge we’re up against.”
On average, symptoms of COVID-19 appear within five days but can show up 14 days after a person is exposed. So, even those with more severe symptoms could spread the virus for days before deciding to get tested and learning they’re infected.
Frenk lived through the H1N1 pandemic and Ebola outbreak as dean of the faculty at the Harvard School of Public Health. The standard response to any outbreak, he said, is containment—meaning that you take a case, test it, then work backward to find those people who the infected person had been in contact with physically. Then, you isolate those people and interrupt the transmission.
Only 3,237 of cases in the U.S. were travel-related or due to close human contact, according to the Centers for Disease Control and Prevention (CDC). The vast majority of cases were the result of community transmission and by the time containment measures were implemented, the disease was already widespread. At that point in the outbreak, interrupting the transmission of the virus wasn’t feasible on a large scale, so the response effort moved to mitigation, Frenk said.
To do that, state officials created social distancing policies that closed non-essential businesses and schools and barred social gatherings. Some argue the measures aren’t doing enough and it’s time for President Donald Trump to implement a national lockdown similar to the actions taken in Italy and Spain, where two large outbreaks are occurring.
Based on America’s size and diversity, Frenk said he was skeptical that a national lockdown was a viable option and added the measures taken at state and local levels is a vastly more feasible alternative.
“But, it is important that every place takes this seriously and institutes and enforces these measures in a timely fashion,” Frenk said. “Delays end up becoming very costly.”
Without taking these mitigation measures, Dr. Deborah Birx, a member of Trump’s Coronavirus Task Force, said the death toll could have ranged from 1.6 million to 2.2 million people. Current projections from the Task Force put the death toll around 100,000 to 200,000 but officials who urge people to adhere to social distancing guidelines said every individuals’ actions could save more lives.
In announcing an extension to his 15-day plan, Trump said he expects the country will be well on its way to recovery by June 1, but this might not be the last time America sees SARS-CoV-2. One of his top coronavirus advisors, Dr. Anthony Fauci, director of the National Institute for Allergy and Infectious Diseases, said the virus could be on a seasonal cycle. If southern Africa and Southern-Hemisphere countries, who are going into their winter seasons, have a substantial outbreak, Fauci said the country needs to be prepared to be hit again.
Based on his experience, Frenk said it’s very possible the virus could have some seasonality and predicted there could be another “wave” of the virus in the fall. By that time, he expected there would be better diagnostic tests and therapeutics that could at least lessen the symptoms, if not serve as a cure.
Frenk called on America and countries around the world to continue investing in public health. During an outbreak, when everyone is paying attention, public health receives “extraordinary resources,” he said, but once the crisis is over, that support dissipates.
He added that he is confident the United States will get through the current coronavirus outbreak. But it won’t be the last one and next time around, the virus could be just as contagious but more deadly, so he said he hopes this is the “wake up call” the world needs.
“You don’t stop investing in your armed forces when there’s no war. You keep having them ready and we don’t do that when it comes to these wars against these invisible enemies,” Frenk said.