Public health expert says US efforts to limit pandemic have been hurt by politicization and because people have opinions ‘not based on science’
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.
Dr. 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 Dr. Rasmussen the rush to create vaccines and the need for proper clinical trials. Dr. 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 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 the concerns when traveling.
Friedson explores women in stem cell research and the lack of exposure facing women in scientific fields.
To hear the interview, go to the Coronavirus Unmasked podcast . A transcript of the interview follows.
Dr. Angela Rasmussen: Thank you so much for having me, Felice.
The Media Line: Quite a pleasure! 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?
AR: So, 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 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, 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.
TML: So, 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?
AR: So, masks are actually a great example actually of how the messaging for this has really gone off the rails. So 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. And while 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. And 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 say 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.
TML: Do you think people are not taking this pandemic seriously? Or are they exhausted by the safety routines?
AR: 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 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.
TML: Please help debunk some of the myths the public are 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?
AR: So, one thing that we do know, you know, one thing I try to focus on because 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 that you just pointed out that are active areas of research. So, I try to focus on the things that we do now. We do know that this virus is largely transmitted or at least the major driver of transmission is respiratory droplets for presymptomatic people, as people who don’t know that they’re sick yet. That is what one of the things that makes 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 out sort of, as you mentioned, 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.
TML: Dr. 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?
AR: So, 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’s any safety issues or a large, high rate of adverse events associated with death 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 even if we have, and this has been very confusing, I think for people to understand, so 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 which 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 [inaudible] 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? And 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.
TML: So, I’m right in stating that you need that clinical trial time to be able to catch up with the vaccine, to see if it is going to work properly and effectively.
AR: That’s correct. And there is you know, the vaccines that are going under these Phase Three trials are really, really effective, it may be that we can take some time off. If there’s no cases of coronavirus or COVID-19 in the people who received the experimental vaccine early on, you might be able to conclude that at least you can do a sort of phased rollout of the vaccine and conclude that it might be at least partially effective. And I think that that’s probably what the plan is. That the main thing is to make sure also that the vaccine is safe. And while the Phase One trials looked at safety, that means that people who’ve just gotten the vaccine aren’t going to get sick, we also do need to keep looking at safety because there have been experimental SARS Classic vaccines that were developed that in animals anyways could actually make the disease worse. So, we need to make sure also that that’s not happening, but something like that, an adverse effect like that, would probably become apparent pretty early on in a Phase Three trial. So, we would have that information, at least, quickly. I think that if they have any indications of efficacy and no indications of serious adverse events like that, they’ll probably move forward with the first vaccine that gives those results, even though it hasn’t gone through the normal standards of rigor for a Phase Three clinical trial.
TML: What have you seen in terms of reinfestation?
AR: So, reinfection/reactivation has been a question. There have been these cases reported of people who are testing positive after recovering from COVID-19 and [then] testing negative. And that partly has to do with how the tests work. So, the test actually looks for the genetic material of the virus, but it doesn’t actually measure the infectious virus. And that’s really important because a virus is only infectious when that genetic material is made and then packaged into what we call the capsid, or the cell that surrounds it. And then that’s covered by the membrane that everybody has heard about, the lipid covering on the surface from which those spike proteins protrude on the virus particle. The RNA alone, the genetic material, is produced in cells sometimes long after the virus is actually replicating and making these new infectious virus particles. So, it’s thought that that’s what those tests are detecting. But people have done a couple of studies just to make sure that that’s what’s happening. In China, they experimentally infected four rhesus macaque or monkeys, allowed them to recover from COVID and then challenged them again with another dose of virus and the animals did not become reinfected, which suggests that they did develop protective immunity after the first infection. In addition, because of some of these so-called repositive cases, the South Korean CDC did two things: They conducted an epidemiological investigation to make sure that none of those people who were testing positive again, were associated with any new cases and they were not. They also tested those people for infective virus. So, they were looking not only for the genetic material but looking to see if virus particles capable of infecting cells were being produced and they were not able to detect any. So that really does suggest that the tests are picking up sort of residual genetic material from a dead virus that is not infectious any longer and that people are probably not being reinfected. But a really open question that we don’t know is, how long any kind of protective immunity lasts? So, if you’ve recovered from COVID, will you be protected? And we don’t know that, and really the only way to determine that is to continue following people who’ve recovered from COVID and see how many antibodies are they making and do any of them become infected again.
TML: The coronavirus was first identified by a woman named Dr. June Almeida in 1964 at her laboratory in St. Thomas’ Hospital in London. She is slowly getting long-overdue recognition. Why is the gender disparity still so great among women, epidemiologists and virologists?
AR: Well, the gender disparity exists, unfortunately across all STEM fields. And there are many cases of, you know, these hidden figures, women and people of color, especially black and indigenous people of color who have really been a race from scientific history. So, it’s certainly not limited to virology and epidemiology. But I think it’s long overdue that people like Dr. Almeida are being recognized for their contributions to this area. People really even asked her if she discovered coronaviruses, not very many people worked on coronaviruses. They were thought to be either, you know, minimally important human pathogens. There’s only four coronaviruses that were known before SARS Classic emerged. And they all cause common cold-like disease. Most of the other coronaviruses that were known cause veterinary diseases. There are coronaviruses that infect cats, for example. So people weren’t really, they weren’t on anybody’s radar as something that we really needed to pay that much attention to or devote that much funding to. And I think specifically in [Dr.] June Almeida’s case, they were really ignored except for the sort of niche groups of people that study coronaviruses. And unfortunately, most of those people are men, most of those people are white men. And as a result, they tend to have their accomplishments amplified by their peers. Whereas June Almeida’s contributions were, were sort of, not intentionally forgotten necessarily but just forgotten and associated with the men in the room. And I, you know, we still experience this a lot today. I’ve done lots of interviews with one of my male colleagues and they will be referred to as doctor or professor and I will be referred to as Angie which, you know, I normally, I’m fine if people want to call me Angie, but also to be called the man Angie, you know. And we have the same degree and the same qualifications to be talking on this subject. And this unconscious bias, I think really has seeped in very deeply across really all of society, but it’s especially common in the STEM fields. And I think a lot of people don’t even realize that they are contributing to it even by little things like referring to my male colleagues by their professional title and women, their female colleagues, by their first name. So, I think it’s a problem that’s deeply ingrained. You could almost say that it’s part of our social DNA and it’s something that we really need to be conscious of so that we can actually be proactive about eliminating those unconscious biases. And I think that will help (hopefully) the scientists of the future ensure that women are getting the same recognition as their male peers and the recognition that they deserve.
TML: You reside in New York but you’re not there currently. Are you comfortable flying commercial airlines at this time?
AR: 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 hotspot in Seattle to New York which was a growing coronavirus hot spot at that point. Now neither Seattle nor New York are coronavirus hotspots. 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. I think if I – 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 actually 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 continuing to stay home as much as possible and not travel by air again, unless it’s absolutely necessary.
TML: 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 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?
AR: So, 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. Now that said, people have been infected, it seems like, 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 sort of 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. So, most of the people who’ve gotten infected on these planes in these influenza studies that I just mentioned were sitting immediately near that person. They were either in the same row or they were a row directly in front or behind them. And even though planes do use recirculated air, it’s filtered so and 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. So, 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.
TML: On that note, Dr. Angela Rasmussen, many thanks for your knowledge and your time. Stay safe.
AR: You too, Felice. Thank you so much for having me.
TML: You’re welcome.