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Sunday May 16th

Pandemic 101: What an infectious disease expert wants you to know about COVID-19

<p>Dr. Myron Cohen, MD, has studied and worked with infectious diseases for 40 years. Photo courtesy of Dr. Myron Cohen.</p>
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Dr. Myron Cohen, MD, has studied and worked with infectious diseases for 40 years. Photo courtesy of Dr. Myron Cohen.

Dr. Myron Cohen has studied and worked with infectious diseases for four decades and has served as the director of the UNC Division of Infectious Diseases since 1988. 

In addition to working as a professor in the School of Medicine and the department of epidemiology within the Gillings School of Global Public Health, Dr. Cohen is also the director of the UNC Institute for Global Health and Infectious Diseases and associate vice chancellor for global health. 

Dr. Cohen also served on a COVID executive committee with Chancellor Kevin Guskiewicz that helped decide the University's response to the virus. 

On Tuesday, Dr. Cohen spoke with DTH reporter Hannah Lang about the COVID-19 pandemic, what it means and what individuals can do to combat the deadly pathogen. This interview has been edited for content and clarity. 

The Daily Tar Heel: So, what exactly is a pandemic? 

Dr. Myron Cohen: So, you know, epidemic versus pandemic — these are kind of simple words, really. Epidemic, everyone would see as the spread of an infectious disease. Pandemic, the definition of it is that there's sustained transmission of a disease on multiple continents ... A pandemic just indicates the gravity of the distances with which the agent is spread.

We all have kinds of food-borne epidemics in the United States, so you read all the time about 'food company X' had a breakdown in their factory and there's salmonella hadar in chicken livers, and it was in New York state. That's an epidemic. Those chicken livers never made it out (of the state or country). That's not sustained, right? Once you eat the chicken livers, it's over. Whereas, a pandemic is sustained transmission — so it's a communicable disease — and it's much more widespread. 

DTH: Are there any historical examples of pandemics that we can look to or draw from? 

Dr. Cohen: We always talk about the 1918 flu pandemic ... Medical care was much more rudimentary, so the mortality was very very high, and almost everyone has a relative — a grandparent of a grandaunt or somebody — who died in the 1918 flu pandemic. That's the place we look for historical perception of what happened.

As you see people on television talking about how they're going to try and drag this out and flatten the curve ... that idea surfaced in 1918, where there were a couple of cities that did exactly that, and they dragged out the peak...

DTH: We've already seen this pandemic begin to have an impact economically, academically, etc. How much disruption can we expect?

Dr. Cohen: Almost nothing will be left untouched by this...  It's disruptive in every way. But there's some good news: Look at the fact that this seems not to affect children. No child under nine has died. Young people seem to do really well with this. The death rate under 50 is 1 in 500, which is pretty low and it's much lower in your age group...

Most of the infectious disease experts like me, who are older, we are not happy about this, we're thoroughly unhappy. However, I'm somewhat relieved that children and grandchildren (are better off). If this were the flu pandemic of 1918, it would not be limited to my age group. It affected all age groups. Lots of kids died of influenza. We feel some minor solace in that. It appears for the most part to be much better tolerated by young people who get it.  

DTH: What about the effects on the United States' healthcare system, or political system?

Dr. Cohen: The healthcare system, we're going to see... Everyone's predicting that if this is as bad as it is in Italy, that our hospital system mathematically can't tolerate it. That if we have too many infections, too many people in intensive care units, we'll overwhelm the system. That may or may not happen. We pray that doesn't happen. We pray we reduce the number of cases to the number that we can manage. I mean, UNC has been preparing for weeks for the worst case scenario. But we pray that the worst case scenario does not transpire. 

The political system is complex, because we have a very complicated political system... I have no idea how this ends. There's a lot of possible endings to this, and you're going to get to watch it all unfold. You're going to get to watch the epidemic unfold, the treatments unfold. There's going to be a lot of death and sorrow before we get out of this, in all candor...  It's a very fatal pathogen for older people, and we just have to face that fact. So you're going to see this all unfold in the next six months and I have no idea how it's going to unfold. The economic disruption, the disruption to your life is going to be continuous for at least a few months. And then we'll see what happens by the summer or the winter. A lot of things can happen.  

DTH: Is there difficulty in fighting an invisible enemy?

Dr. Cohen: HIV I've worked on my entire career, 40 years. You've got to look at what HIV was: '80 to '84 we didn't know what caused AIDS, and then '84-2000 we didn't really know the rules. COVID-19, with modern technologies, we've only had availability to study this for six weeks. We already know some of the rules, (but) we don't know all of the rules that are governing this... Once we understand the rules to interrupt transmission — to one way or the other interrupt severe disease — this will just be a whole different planet. And how long will that take us, is the question. 

And then we have Mother Nature on our side, because respiratory infections are usually seasonal. So there's a lot of hope that this will prove to be seasonal, giving us more time to understand the rules better. I can't tell you how many articles a day are published on SARS-CoV-2. It's like an article every 10 minutes of people telling us their experiences. And we try and follow this worldwide, and we all talk to each other worldwide every day, trying to better understand these rules and have better and better plans.

The current strategy is very medieval. Everybody remembers the (Bubonic) plague... noblemen ran to the hills. That was carried by fleas, (it had) a different biology, but just disperse, and hide — that's kind of what we're doing now. Until we get the rules in place and some medications, we have no choice but to use very ancient methods of blunting infections. 

DTH: Speaking of those methods — what is social distancing, and why is it important? 

Dr. Cohen: ... Without knowing all the rules, our hands are a little bit tied. So the social isolation part is very simple: it suggests that if the most probable transmission is from someone with an infection who sneezes or coughs and sends the virus three or four feet into the air, if you're not three or four feet away, you're not going to get infected right? You're in your house right now, and no one's there. So there's just no way for you to get infected. 

We're just distancing people with the assumption that the most infections can be avoided by keeping people several feet away from each other for some window of time. We're disrupting the entire planet by doing this, by closing restaurants and sports and everything else — how long can we do this? We're doing this to buy time. You're buying time to reduce the number of people affected, so that the hospitals aren't overwhelmed and we can take better care of people who are affected, and to develop medications. Because those two things are really important. 

DTH: So what is the difference between quarantining and social distancing? 

Dr. Cohen: This is a nomenclature thing. We use the word "quarantine" right now, in this context, for what are called people under investigation, PUI. So somebody comes from Italy, or France or Germany today. And because they've come from those locations where infection rates are so high, they are quarantined until they can be excluded as infected by time... Now, social distancing — that's different from quarantining. You're keeping yourself six feet away from somebody else. Isolation is what we do when somebody actually tests positive. They're going to probably be well, but they're almost certainly contagious. So then we separate them through isolation for two weeks, or until their virus shedding abates. 

DTH: What advice do you have for our readers as look forward to these next few months of uncertainty and disruption? 

Dr. Cohen: We are confronted with a novel, emerging pathogen that has the possibility of fatality, especially for older people. For college students, this is going to pass. This window of time will pass. There will be suffering and sorrow in different families, unequivocally. There already has been and there will be. But this will pass. 

The current government and scientific infrastructure will help make this go by faster. There'll be lessons learned from this through the disruption. On a mega level, you just have to live through this. So it's going to be several months, and it's going to be unpleasant months. And you have to live through it. 

From a personal protection level ... right now the best strategy is: great maturity at social intercourse, reducing the number of people you spend time with to a small number that you're comfortable with... avoiding big crowds, washing your hands a lot, avoiding touching your face and eyes a lot — as much as you can. For people who wear glasses, I strongly encourage you not to take your glasses off. It keeps your hands away from your eyes. .... 

The way to stay safe is exactly what you're already doing: you've got an apartment, you've got a few friends who are well. If all of you behave responsibly, probably you won't get infected, and then your parents won't get infected, and we'll slow the whole thing down and then one day in July or June somebody will say, 'The Chinese report that drug X works' — and then drug companies will make huge amounts of it and all of us will use drug X. And it will be a magical ending to a terrible window of time. 


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