‘Autumn really worries me’
As fall approaches in much of the world, many people are anxious about what will happen when cold weather forces people indoors. Will the virus resurge with a vengeance, especially as people return to offices and schools reopen?
To get a preview of the fall, we spoke to Donald G. McNeil Jr., The Times’s infectious disease expert, whose job has become envisioning the future of the coronavirus crisis.
We’ve been warned about a “fall wave” for a long time, but then we had a bad summer wave. What most worries you about the fall?
I try to avoid “wave” metaphors because each outbreak is unique. New York City and Sturgis, S.D., both had bad ones, but months apart and for different reasons: New York in February because of tourists returning from Europe; Sturgis in August because of a motorcycle rally where masks were disdained.
But yes, autumn really worries me. Outbreaks are exploding at colleges all across the nation. There may initially be fewer deaths because students are young — but professors aren’t.
And soon, chilly weather will drive people indoors, where studies suggest you are 20 times more likely to get infected. By midwinter, if we aren’t careful, the death toll could head back up toward its April apex.
How will celebrating the holidays be different this year?
No American wants to hear this, but experts say it probably won’t be prudent to have big indoor family gatherings for Rosh Hashana, Thanksgiving or Christmas. It’s sad, but I don’t see a safe option — especially for families with a child away at school. When college towns become epicenters, you really don’t want students to come home and unwittingly infect their families. And students need to consider this: Yes, it’s miserable to miss a family holiday — but could you forgive yourself if your grandmother died because of you?
What scientific developments are you following most closely?
Scientists I talk to are optimistic about monoclonal antibodies. One called them “convalescent plasma on steroids.” The best antibodies are cloned and grown in cell broths. Small doses might act like vaccines that protect for a few weeks. If they do, getting them to high-risk Americans — medical workers, nursing home patients and the families of the infected — could blunt the epidemic. But they can’t be grown in bulk quickly or cheaply, and F.D.A. approval for prophylactic use is uncertain.
President Trump has pledged to have a vaccine before the end of the year. Is that realistic, and if so, would there be safety concerns?
Vaccine experts I talk to are very nervous right now.
Actually, many of them believe that by late December or January, we may have solid proof that one — or even several — vaccines are safe and effective. That would be very good news.
What they fear, however, is an “October surprise,” the possibility that, to boost his chances on Nov. 3, President Trump could pressure the Food and Drug Administration to grant a premature “emergency use approval” for a vaccine. (The F.D.A. did that for hydroxychloroquine and convalescent plasma based on data that many scientists felt was weak.)
There are three ways that might happen:
The most shocking would be if the F.D.A. just used the Phase 2 and monkey data that it already has. But that’s what the Russians and the Chinese did, and it caused an outcry here. Americans might feel like guinea pigs, shun the vaccine and be angry at the administration for trying.
The second would be for the F.D.A. to pressure the trials’ data safety monitoring boards to divulge what they know. As a safety precaution, those independent boards look at partial data before the trial finishes to make sure no participants are being hurt. They normally keep anything else they learn secret. But if a vaccine looked even partly effective, the F.D.A. might approve based on that. However, experts think it is unlikely the boards will have enough data by early November. They also say that vaccine companies might actually fight an F.D.A. approval in court if they think it’s dangerously premature.
The Coronavirus Outbreak ›
Frequently Asked Questions
Updated September 1, 2020
Why is it safer to spend time together outside?
- Outdoor gatherings lower risk because wind disperses viral droplets, and sunlight can kill some of the virus. Open spaces prevent the virus from building up in concentrated amounts and being inhaled, which can happen when infected people exhale in a confined space for long stretches of time, said Dr. Julian W. Tang, a virologist at the University of Leicester.
What are the symptoms of coronavirus?
- In the beginning, the coronavirus seemed like it was primarily a respiratory illness — many patients had fever and chills, were weak and tired, and coughed a lot, though some people don’t show many symptoms at all. Those who seemed sickest had pneumonia or acute respiratory distress syndrome and received supplemental oxygen. By now, doctors have identified many more symptoms and syndromes. In April, the C.D.C. added to the list of early signs sore throat, fever, chills and muscle aches. Gastrointestinal upset, such as diarrhea and nausea, has also been observed. Another telltale sign of infection may be a sudden, profound diminution of one’s sense of smell and taste. Teenagers and young adults in some cases have developed painful red and purple lesions on their fingers and toes — nicknamed “Covid toe” — but few other serious symptoms.
Why does standing six feet away from others help?
- The coronavirus spreads primarily through droplets from your mouth and nose, especially when you cough or sneeze. The C.D.C., one of the organizations using that measure, bases its recommendation of six feet on the idea that most large droplets that people expel when they cough or sneeze will fall to the ground within six feet. But six feet has never been a magic number that guarantees complete protection. Sneezes, for instance, can launch droplets a lot farther than six feet, according to a recent study. It’s a rule of thumb: You should be safest standing six feet apart outside, especially when it’s windy. But keep a mask on at all times, even when you think you’re far enough apart.
I have antibodies. Am I now immune?
- As of right now, that seems likely, for at least several months. There have been frightening accounts of people suffering what seems to be a second bout of Covid-19. But experts say these patients may have a drawn-out course of infection, with the virus taking a slow toll weeks to months after initial exposure. People infected with the coronavirus typically produce immune molecules called antibodies, which are protective proteins made in response to an infection. These antibodies may last in the body only two to three months, which may seem worrisome, but that’s perfectly normal after an acute infection subsides, said Dr. Michael Mina, an immunologist at Harvard University. It may be possible to get the coronavirus again, but it’s highly unlikely that it would be possible in a short window of time from initial infection or make people sicker the second time.
What are my rights if I am worried about going back to work?
The third possibility would be that the Oxford/AstraZeneca vaccine, which started testing early in Brazil, gets approved in Europe by October, and the F.D.A. echoes the approval — even though the Europeans set a lower standard of proof than the F.D.A. did for American manufacturers.
“That’s what keeps me up at night,” one expert told me.
Is there any hopeful news about the virus that we can lean on as the pandemic carries on?
Yes, absolutely. I’m optimistic that there will be safe vaccines pouring out of factories by sometime next spring, and that this will all be over far faster than I expected just a few months ago.
What else we’re following
What you’re doing
Having some extra time, my fiancé and I decided to volunteer at our local shelter as kitten snugglers. The idea is to hold feral kittens in your lap for a while to help them get familiar with human touch and help them get adopted quicker. It has been amazing to get regular snuggles and relieve my kitten fever without me bringing another cat home!
— Õnne Allaje, Tartu, Estonia
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