Duke Experts Address Coronavirus Testing Issues

Wednesday, April 22, 2020
By Eric Ferreri

Dr. Michael “Dee” Gunn, Dr. Christopher Woods and Thomas N. Denny

A desire to end social distancing and re-open the American economy is a short-sighted approach that could yield disastrous results, because we simply don’t have good tests on hand yet to figure out who is safe, Duke experts said Tuesday.

The three experts spoke with media Tuesday on myriad topics related to COVID-19  testing. Here are excerpts:

ON CALLS TO REOPEN THE ECONOMY

Thomas N. Denny, CEO, Duke Human Vaccine Institute

“I’m concerned that this rush to forget everything we’ve been through in this last six weeks or eight weeks is gaining momentum that is a bit premature. You can start small and then you watch and be ready to do contact tracing and testing in that area, and you build on it. I’m concerned we’re going to find ourselves potentially in a worse shape that we’ve been through the last six weeks if we go too fast on this.”

“I know there are a lot of people who have lost jobs and lost income. They may be motivated by those concerns and I understand that. But we can deal with that on a national level as opposed to forgetting everything we’ve been through the last eight weeks and take this a bit slower.”

Dr. Michael “Dee” Gunn, professor of medicine

“The people that are advocating that we eliminate social distancing right now and that we just completely open up the economy, what they’re really advocating for is that every single person in this country become infected with coronavirus. Because that’s what’s going to happen if we throw things wide open. If you like your grandmother, you might not want to do that.”

“I completely understand people’s frustrations. I think one of the reasons they’re frustrated is no one has given them a clear picture how this is going to advance. No one has shown them the light at the end of the tunnel. One of the things that would be very beneficial, if we could do it at the federal level, is, ‘Here’s the schedule we’re on; here’s where you are on that line.’ ”

“Give people an expectation to work with and clearly explain the benefits. If we leave it where we are now, where everything changes every day, well, no wonder everyone is frustrated."

Dr. Christopher Woods, professor of medicine, infectious diseases

“We do need a clear message. Most suggest a phased approach where percentages of folks are going back to work. I think there’s a lot of compelling rationale for that. You don’t want to do things all at once, but I think we do realize there needs to be some progress in that regard. I suspect most of us agree that will be taking place over the next six months. We will … continue to have the need to do this containment, circles of containment, identification of where the cases are occurring. We may have to have statewide stay-at-home orders imposed if there’s a new surge of cases in a location. We do need clear guidance, and that needs to come at the federal level, and it needs to be supported and slightly modified at the state and local levels.”

ON SOCIAL DISTANCING, AND WHAT COMES NEXT

Woods

“We’re all due a measure of congratulations so far with this approach to social distancing … we are seeing that flattening of the curve that you hear so much about, which reduces the pressure on our health systems.”

“What it harkens to is an expected transition from the mitigation approach that we’ve been in, where we’re reliant on social distancing, to a containment approach that really relies on testing, contact tracing and then the isolation that takes place. The problem with the outbreak, when the virus initially entered here in the U.S., those tests were not widely available and are still not quite where we would like them to be. We need those tests to detect the presence of virus in order to perform that contact-tracing and isolation approach as we make that transition back to containment. We need to have tests where we understand their performance characteristics. Ideally, we’d have those results quickly. That means we can be more precise in how we put into place our public health interventions.”

“There are a number of studies that will be done by our public health bodies … that will look at the prevalence of the disease and the prevalence of antibodies in certain populations to give us a sense of where we stand in regards to a herd immunity. See where we stand in terms of a herd immunity. We’ve done such a good job of social distancing that we expect the rate of immunity to be quite low, which means we would expect there to be, over the course of the next several months, periodic outbreaks of the disease. But now we hope to have the diagnostic tools and the public health tools to contain those outbreaks as they occur.”

ON WHAT LEVEL OF TESTING IS NEEDED TO REOPEN THE ECONOMY?

Gunn

“People envision that we have to test every person on a weekly basis. That’s not true. It’s the same thing that happens in a forest fire. Once you get the fire under control, it’s an issue of managing the hot spots. What we need to do very efficiently is identify people who are at risk of being infected, that have been in contact with people who have had symptoms, or a positive test, and then rapidly be able to test those people to cut down on the spread very quickly.”

“This is a fast-moving virus so this may require a technological solution. You’ve probably heard of apps that monitor who you’ve been close to. With a very robust tracking system, it reduces the number of tests that are required.”

ON HOW FEDERAL, STATE AND LOCAL HEALTH OFFICIALS WORK TOGETHER 

Woods

“It will be location-dependent. We require substantial national leadership from our national public health entities, but ultimately at the state level, that’s where the data will be available to make the best decisions about where to invest current resources and where to direct subsequent resources. In a state like North Carolina, we are fairly democratized. The decision-making capacity is heavily focused at the county level. There will be, appropriately so, involvement at all levels … with a good dose of those of us doing research at the academic level contributing our expertise.”

Denny

“There needs to be a strong national component of support. This is going to be costly. It’s going to take a lot of people to execute these plans. I do believe at the end of the day, the testing part of it has to be very local. You go into each local community and you work with your public health teams and you try to identify those within each setting, who are at the most risk, and work out in rings. We talk about rings of containment. This is the same concept: You start with those at the most risk -- potentially those in lower socioeconomic groups that typically see more health problems, and work away to lower-risk individuals. All this is going to take time. You can’t get it done overnight.”

ON PREDICTING HOW MUCH TESTING IS NEEDED IN NORTH CAROLINA

Gunn

“The reason we can’t give you a straight-forward answer -- it kind of depends on the situation. It’s not an all or none, where all of a sudden we eliminate social distancing. This will be a staged rollout in different populations. One of the things that determines the tests we need, is what is the level of infection when we eliminate social distancing. If there are still a lot of infections going around … we’re going to need a lot of tests.”

“If we can really tamp down our ongoing rate of infection, it’s much easier to track the hot spots. But if you’re not doing it, if you don’t get that baseline down, it becomes a game of whack-a-mole.”

ON WHAT IMPORTANT STEP SHOULD BE TAKEN RIGHT NOW

Denny

“The political leadership has to be consistent on a day-to-day basis. I believe they have to take their lead from the public health experts to provide the best scientific information and data. The public has a short attention span on a lot of these issues.”

Gunn

“The thing the federal government could best do right now is come up with a plan. The American people are very willing to sacrifice for the common good, but we need a coherent plan that everyone can follow. Someone needs to say -- OK, here’s the plan. We’ve taken the best advice, we’re going to move forward and we’re asking you as individual citizens to buy into this plan, because that’s how we’re going to get control of this pandemic

Meet the experts

Thomas N. Denny
Chief Operating Officer, Duke Human Vaccine Institute
Thomas Denny is chief operating officer of the Duke Human Vaccine Institute, a professor of medicine and an affiliate member of the Duke Global Health Institute. Denny was previously a consultant to the U.S. Centers for Disease Control and Prevention.
thomas.denny@duke.edu

Dr. Christopher Woods
Professor of Medicine, Infectious Diseases
Dr. Christopher Woods is co-director of the Hubert-Yeargan Center for Global Health at Duke and chief of the infectious diseases division Durham VA Medical Center. He is also associate director of the Duke Center for Applied Genomics and Precision Medicine. A professor in pathology, Woods specializes in emerging infections, global health, epidemiology, antimicrobial resistance and surveillance of communicable diseases.
chris.woods@duke.edu

Dr. Michael “Dee” Gunn
Professor of Medicine
Michael “Dee” Gunn is a professor in immunology at Duke University School of Medicine.
His work focuses on innate immune responses to specific diseases. Gunn also works on developing diagnostics and therapeutics for a variety of human diseases.
michael.gunn@duke.edu

Original story published by Duke Today on April 21, 2020

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