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Deborah Birx, M.D.: Lessons From the Pandemic

The U.S. coronavirus response coordinator explains what we've learned about the virus so far

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ERIC BARADAT/AFP via Getty Images


What have we discovered about how to treat this virus?

We've learned a lot about how to treat the seriously ill. Our hospitals and our doctors and nurses have done an extraordinary job improving the care of the sickest patients. There are nuances about when people need oxygen, how much oxygen they need, whether they need to go on a ventilator, when that should happen, how they should be positioned — those are all really critical knowledge. That has been improving in-hospital and in-ICU care.

What kinds of changes do you believe will occur in the U.S. health care system as a result of this?

I think two big things are happening. One, we know where every ICU bed and ventilator is in the country. Having that up-to-date inventory is important when you're managing any pandemic. We have much more visibility across the country into what the health care system has and how it needs to be additionally supported.

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Secondly, we clearly know that you need to take better care of yourself. You need to ensure your hypertension is under control, your diabetes is under control. If you have those risk factors, people need to immediately protect themselves.

Any other lessons learned?

We have discovered how vulnerable our long-term care facilities are to infectious diseases. Our CMS group [Centers for Medicare & Medicaid Services] is always focused on infection control in nursing homes, but we've learned how even more critically important it is that nursing homes have excellent infection control.

What have we learned to help us change our behaviors?

I hope that out of this comes significant recommendations to decrease human exposure to wild animals. It's the wild animals that we don't have everyday exposure to — we have no ability to handle their viruses, particularly if they jump to us. HIV came out of wild animals. Ebola comes out of animals in the wild, and we believe that COVID-19 came out of animals in the wild. Any time a virus moves from an animal to a human, humans have no immunity. That's what has been so difficult with this particular virus.

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As states reopen, what advice can we offer older people?

We want to make it clear that we still have significant concerns about people with preexisting conditions and the elderly. We know that they are the most susceptible to a more serious outcome, both hospitalization and potential fatality. People with preexisting conditions should stay at home. When going out, they should use a mask.

What's the risk of reinfection for those who've already been ill?

The piece of this that should be reassuring to people is that when you get an infection and you make antibodies, your body remembers how to do that. You may not currently be making antibodies, but as soon as you get reinfected your body remembers that and then quickly makes antibodies — much quicker the second time. People shouldn't be concerned that their antibody levels may wane, because if they do get reexposed, they'll make antibodies very quickly.

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What should people look for in their home states?

All states should be doing really, really critical surveillance in long-term care facilities out of concern that an asymptomatic worker or an asymptomatic person who comes into the nursing home may unknowingly spread the virus to its residents.

Will we find “patient zero"?

You will absolutely be able to get that level of clarity, including in which countries the travelers from China began that initial spread, country by country.

There are extraordinary evolutionary molecular biologists who can really figure this out for us. They'll be able to re-create in great detail where this virus came from, how it traveled around the globe, and where different countries had seeds of that virus introduced and when they were introduced.

Can we develop a universal vaccine for different strains of the coronavirus?

The coronaviruses in general are fairly stable in their protein matrixes. That's the good part. Of course, we don't have experience with this virus. The hope is a vaccine that is made today against COVID-19 will work tomorrow and will work a year from now.

How can we learn about the search for a vaccine?

Any American can go to the NIH website. It lists every single trial that is going on, every clinical trial for COVID-19, whether it's vaccines or therapeutics, so Americans can stay informed.

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