Epidemiologist looks at COVID future and WHO funding

SHARON — Criticism lodged against the World Health Organization (WHO) for its handling of the COVID-19 pandemic by the administration of President Donald Trump, including the withholding of millions in funding, is “completely unfair and a political act to divert attention to the tardy and ineffective response by the U.S. government,” said Sharon epidemiologist James Shepherd. 

Shepherd, an infectious disease consultant at Yale-New Haven Hospital, has had a bird’s-eye view of five separate global spreads of relatively new viral infections during his decades-long medical career. He spent a year embedded in India with the WHO working on a tuberculosis control program as an advisor to that country’s government. Shepherd said there is no doubt that the WHO has had its share of problems in the past, including mismanagement of the Ebola outbreak in West Africa in 2014. 

During that epidemic, said Shepherd, the organization, which is an agency of the United Nations responsible for public health, spent “a lot more time soothing anxious members, rather than organizing an international response to the outbreak. It learned a lot of lessons.” 

But this time around with the novel coronavirus (or SARS-CoV-2 or COVID-19), he said he feels that the punitive action leveled against the organization by the United States is unfounded.

A brand new pathogen

Shepherd said the novel coronavirus likely infected its first human victim in mid to late November of 2019, perhaps “associated with a wet market in central Wuhan City where they sold exotic wild animals for Chinese food.” 

He noted that Dec. 8 was the first human cluster recognition by the Chinese authorities, and most infectious disease doctors outside of China first became aware of a new pneumonia spreading in Central China on Dec. 31 from Chinese reports and mail from the epidemiologist news monitoring service ProMED. 

Faster rate of reporting

The speed at which the WHO responded to first signs of the COVID-19 outbreak was “remarkable,” in comparison to a weak showing in 2014 during the Ebola outbreak, Shepherd related in a telephone interview on Thursday, April 16. “We had an amazing amount of scientific information about a brand new pathogen.” 

Chinese scientists had published “whole genetic sequences enabling us to diagnose novel coronavirus infections in upper respiratory airways through swabbing,” said Shepherd. 

The information, freely available in the literature and GeneBank by Jan. 12, was quickly used by the WHO to publish instructions for making a new diagnostic test for the new virus. 

“The remarkable thing has been that the information sharing between Chinese scientists and the international community allowed us to respond much more quickly than back in 2002 against the original SARS.” 

The WHO, he explained, serves as an advisory body with very limited implementation capabilities.

No other explanation

The doctor said while it would have been premature for the organization to sound the alarm bells before they were positive about human-to-human transmission, and they were reliant on information from Chinese authorities, by the second report in mid-January there was little doubt in medical experts’ minds about how it spreads. 

 “We don’t want them running out of the forest waving their hands above their heads; we want them to be cautious,” he said. “But we all knew that there was no other plausible explanation” of the rapid spread.

The U.S. had the benefit of looking to the events unfolding in China and elsewhere, “but we had feet of clay” and failed to heed the warning early on, said Shepherd. 

“We had not used the time that was granted to us wisely at all, and indeed our public health system remains poorly equipped to deal with the next phase.” 

The result, he said, is that this country was too late in responding, which means a drawn-out recovery is inevitable.It will run rampant again

 In addition to his time working with the WHO in India, the Sharon epidemiologist spent much of his career in Africa and Asia with the national Centers for Disease Control and Prevention (CDC). He also credited the WHO for being the international agency that is “holding the reigns on the global effort to eradicate polio.”

“If we poke our nose out of social isolation right now we are likely to get infected eventually, because most of us are susceptible and have not built up any immunity,” he said. “The only way that we should come out of our houses and flats and start to mingle again,” said Shepherd, who is British, “is if we re-establish the public health infrastructure that we neglected for so long in the United States so that we can identify new hot spots where the virus will emerge and begin to run rampant again, which is for sure going to happen.” 

Social distancing does work

Widespread testing and contact tracing are key to recovery. The problem with long-term social isolation, said Shepherd, is that “Homo sapiens are not built to isolate for very long. They will begin to illicitly mingle again.”

Until a vaccine comes along, which is not likely until after another round of flu/COVID-19 seasons arrive later this year, predicted Shepherd, “social distancing is the only public health measure left and open to us.” 

The good news, he said, is that it has had an impact on slowing the contagion. 

Shepherd stressed that the point about public health infrastructure is that we should be able to identify COVID cases quickly by testing, isolate them, and trace their contacts to find more COVID in the community. 

“These are the basic public health measures that we should have used in January and February but need to use now so that we can come out of isolation.”

Could ‘smolder’ until 2022

Commenting on Connecticut Gov. Ned Lamont’s mandate this week that everyone wear a face mask when out in public, Shepherd questioned its effectiveness, not backed by data, but said a facial covering is one of few options left available to people, since “we missed the boat” on early intervention.

 “We are reduced to a social isolation/self-quarantine approach,” said the health expert. “We have essentially hidden from the virus, so we are highly susceptible because our approach has been to avoid infection rather than to develop a ‘herd immunity.’ 

“We had no choice. We had to protect our health-care system, which would have been overwhelmed if we didn’t isolate,” said Shepherd.

As a result, the epidemiologist said, it is possible that COVID-19 could “smolder” in the U.S. until possibly 2022, the time that it could take for a safe vaccine to be developed. “Skepticism is a healthy state of mind right now.”