As the Bay Area appears to be successfully "flattening the curve" and overall COVID-19 case numbers remain low compared to other parts of the country, a Marin County-based epidemiologist is saying that we should not just be focused on mitigation efforts — which could go on for an extended period — but we can return to containment strategies.
Dr. Larry Brilliant is well known for a TED Talk he gave 14 years ago about bringing an end to smallpox on the planet and trying to stop a pandemic like the one we're experiencing now. He's now the board chair of a nonprofit called Ending Pandemics, he consulted on the 2011 film Contagion that the masochistic among us have been watching on Netflix, and he went on KQED's Forum on Monday to discuss the current situation in California and the Bay Area. He believes public health agencies here need to pivot back to active containment measures and contact-tracing, because the overall number of cases has remained so low.
Brilliant warns further that the Bay Area cannot relax its mitigation efforts or shelter-at-home orders anytime soon, or else we risk a rising wave in new cases. "What we're to avoid is what we call a 'saddle back' or 'ridge back'," he says. "And what we're really monitoring is deaths because the case reporting is so bad... What we say in epidemiology, it's not a very nice thing, but when the virus is in decline, you have to put your foot on the neck. That's not a nice way to describe it, but it's true," Brilliant says.
"California has 388 cases [per million people], whereas New York has 6,600 [per million]. New Jersey 4,100 [per million]," he said. "We have such a small number of cases per capita… With that low number, I believe we should not be just doing merely mitigation and stay at home... If you’ve only got a few cases, like in Marin County I think there’s 70 or 80 active cases, 120 total so far... I think we ought to go and visit everyone of those cases in a hazmat suit. We ought to identify all the contacts. We ought to find all the contacts and then quarantine all of them."
"If you continue to do only do mitigation you run that risk of coming to that 'flattening of the curve,' and then we’re going to have to do the mitigation for months," he said.
"I don’t think we should give up on containment," Brilliant said. "In my experience with smallpox... the moment we let up for a moment, it came back."
Dr. Brilliant also discussed all of President Trump's talk of chloroquine as a treatment for COVID-19. He's had personal experience with the drug having had malaria twice, and he says it's "brutal drug" that he found to be worse than malaria itself. He also added there's a high probability of retinal damage and blindness from the drug.
"You wouldn't want to take it unless it was the only [drug] you had, as with malaria," he says.
Dr. Brilliant sees hope in convalescent plasma antibody treatments, like the treatment that a Bay Area biotech company is currently working on. "The problem with that it's difficult to scale up," he says, noting that for each donor who's had the virus and recovered, they can donate enough plasma to create treatments for maybe three or four people. "We don't have enough people who have had the virus and have seroconverted yet."
He also had some optimism to share that the novel coronavirus is not mutating rapidly, and therefore making an effective vaccine should be possible in the next year.