Updated on Thursday, March 19.
Davidson Hamer has been busy.
A professor of global health at the School of Public Health, professor of infectious disease at the School of Medicine, attending physician in infectious diseases at Boston Medical Center (BMC), and faculty in the National Emerging Infectious Disease Lab (NEIDL), Hamer has been working hard as a new kind of coronavirus disease, now called COVID-19, arose in China and spread throughout that country, around the world, and now here in Massachusetts.
On March 4, he testified at the Massachusetts State House before the Joint Committee on Public Health about the state’s preparedness for COVID-19.
On March 12, Hamer joined a panel of experts for the online Dean’s Seminar—Coronavirus: What Do We Know? What Do We Not Know? What Should We Be Doing? (watch the recorded talk here).
Hamer has also been tracking the spread of COVID-19 as co-principal investigator for GeoSentinel, a surveillance network of 68 sites in 28 countries around the world that gathers health data from returning international travelers and from immigrants and refugees. “There are now dozens and dozens of cases that have been reported within GeoSentinel, particularly all over Europe—and one of the Italian sites is so overwhelmed that they haven’t been reporting,” he says, noting that, as international travel has tapered off, GeoSentinel has fewer returning travelers to test. “There were 16 more cases just reported this morning [Wednesday, March 18].”
And, with over 250 cases now confirmed in Massachusetts, Hamer is working on the efforts to treat and contain the disease here, while also taking frequent interviews with local and national media.
In the midst of all of this, Hamer found a few minutes to talk to SPH about his current work in the pandemic, the status of COVID-19 in Massachusetts and around the world, and what he most wants the public to know.
At this point in the pandemic, what is your main area of focus?
I’m part of a team of physicians in the Section of Infectious Diseases at Boston Medical Center, and we’re having daily emergency planning meetings. We’ve divided into groups, some working on laboratory testing, others focused on treatment, others on personal protective equipment for employees, outpatient protocols, patient education, and prevention and treatment of COVID-19 in socially vulnerable populations.
Our hospital is seeing a lot of patients coming in for testing, some of them sick enough to be hospitalized with respiratory syndromes. None have been confirmed to have COVID-19 as of today [Thursday, March 19]. We have other patients with strong suspicion for the disease.
I’ve been very engaged with both the adult and pediatric infectious disease sections at BMC in developing screening and treatment algorithms for the hospital. I’ve also provided some input to the hospital for emergency preparedness, modeling the epidemic to get an idea of how quickly it could move and what they should be doing in terms of scaling up bed capacity, scaling up ICU capacity, and figuring out the limitations in terms of healthcare workers.
How is the healthcare and public health system in the state holding up?
Hospitals in Boston and across the state are working in almost a war mentality, in terms of the incident command systems that have been set up, and the meetings and constant communication, and the new protocols for donning and doffing personal protective equipment, screening, and treatment.
The problem is that a lot of hospitals and health centers are starting to run out of some of the supplies they need, or are forecasting that they will be running out, so then difficult decisions have to be made about whether we start decontaminating and reusing things that we don’t normally reuse.
The state and Boston really need to have good communication to the public about what’s going on, but also what they should do if they become ill, and where testing centers are available. That’s going to be really key, especially over the next few weeks, because the anticipation is that we’re just at the beginning of a rapidly-rising curve of an outbreak that could peak in two to four weeks. We may have a lot more infected people around—potentially—in a couple weeks, so making people aware of where they can be tested and when they should be tested is really important. The state’s hotline is useful for that.
Is testing capacity improving?
Testing is improving. I can’t say it’s optimal yet, but a couple of things have changed. One is that the guidelines for who should be tested have been greatly broadened, so it’s not just people who have traveled to certain countries or been exposed to people who have traveled to certain countries, because we now have increasing evidence of community-based transmission in the United States.
However, there are still major limitations in the availability of tests. Yesterday, the state announced they can do 400 per day, which is still inadequate. As of yesterday [Wednesday, March 18] they had 256 positive cases, but they’d only tested about 1,700 people so far.
The state lab is now taking about a day to turn around lab results, which is pretty good.
Some commercial labs are now testing, but taking longer: The turnaround time for those is about three days, and that’s a long time to make somebody wait, worrying about potentially infecting family members and friends, and having to do isolation at home. It also makes it challenging if they’re in the hospital, because we’ve been putting them on respiratory, contact, and airborne isolation to the extent that rooms are available (which they still are!), and that means a lot of people waiting on precautions that they might not actually need.
So, testing has improved, and I think it’ll continue to improve, but it’s still a major challenge.
Who should be getting tested, and what should people do if they have symptoms?
If somebody might have had an exposure or starts to have symptoms, even something as minor as a runny nose or sore throat, but definitely a fever, cough, and/or difficulty breathing, they need to consider that they might have developed COVID-19.
Then, depending on the severity, they need to make a decision. If they are having more severe symptoms, or if they’re having mild symptoms but are over the age of 60 and/or have underlying medical issues, they should identify a place where testing can be done. This isn’t necessarily going to be your primary care provider; it’s probably a hospital or public health organization that has testing available. It’s important to know if you’re infected. (Click here for more on deciding to get tested.)
If it’s fairly mild, people can stay at home and self-isolate, try not to have a lot of close contact with family members, wash their hands a lot, disinfect often-touched surfaces in the home, and really try to prevent transmission in the home while they have symptoms.
Amid everything else you’re working on, you have also been taking a tremendous number of interviews with media.
Some of the communications for the general public are to reassure them about the risk of disease and the varying levels of severity in infected individuals, but also to protect those who are at higher risk, and to give information for everyone to reduce their personal risk.
It’s good to have multiple forums where the general public can get an idea of what’s happening, what the challenges are, what the immediate solutions are, what the future holds—although it’s a little harder to predict the medium-term.
One question that comes up constantly is, ‘So, how much longer are we going to be in this social distancing stage?’ The answer is that we don’t really know! I’ve been saying four to six weeks, based on data from past outbreaks where similar non-pharmacological measures have been used, but only time will tell.