An Epidemiologist and COVID-19 Researcher on What Happens Next
Epidemiologist Anne Rimoin, PhD, MPH, specializes in emerging infectious diseases that are caused by animal-human interaction, such as COVID-19. As you might imagine: She’s extraordinarily busy right now. But she graciously gave us some of her time to help us to understand the big question that’s been looming in our minds: How does this all end?
The short answer is: with a vaccine, if we’re able to develop one that’s safe and effective. And in the meantime, the key to anything changing between now and then is widespread testing. We all want nonessential businesses, schools, and public spaces to reopen when it is safe. But as Rimoin reminds us, we can’t simply go back to normal before we have a vaccine—because normal was the problem.
A Q&A with Anne Rimoin, PhD, MPH
We have no way of knowing whether the virus has peaked or not because we don’t have widespread testing in place. That is the only way to know who’s been infected and who hasn’t.
Testing is what will help us understand when we’re going to be able to reopen the economy. Until we have a vaccine, we’re going to have to rely on understanding who’s been infected and who hasn’t, who has immunity and who doesn’t.
Antibody tests are a big question right now. The tests look for antibodies in the blood as an indication that somebody has been infected and mounted an immune response. The hope is that the presence of antibodies is an indication that a person is protected from future infection. However, the World Health Organization has stated that people should use caution interpreting antibody tests. Most of the antibody tests on the market are not very accurate and haven’t gone through rigorous FDA scientific review.
Having inaccurate antibody tests on the market is problematic because people may get a false positive and believe that they have immunity when they actually do not. Furthermore, antibody tests tell you only who’s been infected and who hasn’t. At this time, they don’t tell us whether somebody is immune, how long that immunity may last, or whether a person can be reinfected. Answers to these key questions will play a big part in when the country is reopened and help us understand how many people have had an infection—whether that infection was symptomatic or asymptomatic—and how the disease spreads in populations.
Until we have further information, we cannot say people with antibodies are immune. It’s also quite plausible that we could see that there are varying levels of immunity from person to person. It may not be a black-and-white issue. Immunity might vary based on people’s immune systems, their age, and other factors. There could be only partial protection or people who are not protected at all by antibodies. We are too early in the scientific process to be able to know any of this for sure.
What we’re doing right now is using a blunt instrument: We’re using social distancing to make sure that the virus doesn’t have any way to spread. The concept of herd immunity is important in terms of general disease prevention to make sure that enough people in the population are immune and that those people who do not have immunity are very unlikely to come into contact someone who is currently infected. But the existing antibody tests don’t give us any indication of whether a person is immune or not, so we can’t know whether there is herd immunity.
The first thing that we have to do is get testing up and running. We currently don’t have widespread testing available to determine who is sick and be able to isolate those people. The testing issue is a supply chain issue: We don’t have the reagents or the materials that are needed, and we don’t have the production in place to supply enough tests. We also need to determine who’s been exposed to sick people through contact tracing, which is a very time-consuming process. We have to make sure that those people who have come into contact with someone with COVID-19 are quarantined for an appropriate period of time in order to limit the spread.
We have to be very careful about policymakers creating sweeping economic and social decisions—such as plans to reopen businesses or schools—based on limited data and assumptions based on what’s known about other viruses. We need to understand this novel virus before we move too quickly toward reopening the country. If we reopen too soon, all the incredible gains that we’ve made through the great sacrifices of every person in this country and people globally will lose ground. There will be a resurgence of cases if we don’t have good safety measures and infrastructure in place.
The key thing we need is widespread testing and also testing in key populations, like our health care workers. We need to test our health care workers regularly because having a negative test for the virus today doesn’t mean you’re going to test negative tomorrow.
I’m leading a study at UCLA where we are going to be regularly screening every hospital worker in the UCLA health care system. And once we receive funding, we’re going to be scaling up testing to first responders throughout Los Angeles as well. This regular testing will allow us to see whether these workers are asymptomatically infected and potentially passing it on unwittingly to patients or colleagues or bringing it home to their families, which is a major issue.
We are also planning to collect blood from health care workers to better understand immunity and the outlying questions with antibody tests—whether having antibodies means they’re immune, how long immunity lasts, and whether or not people can be reinfected. These types of longitudinal studies take place over a long period to assess outcomes over time. This study will span a year and will help us assess these extremely important questions that will allow us to protect our frontline health care workers and also determine when it might be safe to reopen the economy.
Anne Rimoin, PhD, MPH, is a professor of epidemiology at the UCLA Fielding School of Public Health and the Infectious Disease Division of the David Geffen School of Medicine. She is the director of the UCLA Center for Global and Immigrant Health.
This article is for informational purposes only, even if and regardless of whether it features the advice of physicians and medical practitioners. This article is not, nor is it intended to be, a substitute for professional medical advice, diagnosis, or treatment and should never be relied upon for specific medical advice. The views expressed in this article are the views of the expert and do not necessarily represent the views of goop.