In recent days, the epidemic of COVD-19, also known as SARS-2, has expanded and become more worrisome. Originating in Wuhan in Central China, there are now cases of this virus infection in at least 29 countries, and according to the World Health Organization (WHO), there is either human-to-human transmission or SARS-2 deaths in Europe (Italy), the Middle East (Iran), and several Asian countries, especially South Korea.

Although the WHO has not yet declared SARS-2 a global pandemic, we seem to be inching in that direction, and it is increasingly likely that this could become an important new respiratory virus infection in the United States. Therefore, a key issue before the American people is our top priorities if this virus gains a “foothold” in the U.S., as suggested by our CDC Director, Dr. Robert Redfield.

Lesson learned from Wuhan – protect our healthcare workers

One of the most troubling aspects of SARS-2 in Wuhan and Central China is how their frontline healthcare workers were exposed to the virus. It has been estimated that over 1,700 Chinese healthcare workers have been infected, including six who died. Included among the reasons for the high rates of infection among this group is a shortage of personal protection equipment (PPE), but also because some SARS-2 patients present without classic symptoms of a respiratory virus infection, such as cough or shortness of breath. For example, it was just reported in the Journal of the American Association (JAMA) that at least 10 health care workers at a university hospital in Wuhan were infected after coming into contact with a patient who was admitted to the surgical ward and presented with abdominal symptoms. The study also found widespread transmission of the SARS-2 virus in the hospital. Our nation’s hospitals must prepare now for a similar situation happening here.

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Protect our older Americans

Some of the highest fatality rates of SARS-2 now occur among individuals over the age of 60 and those with underlying chronic conditions such as diabetes or hypertension. When the first SARS virus hit China in 2003, there was a serious outbreak with deaths in a Hong Kong nursing facility. We should anticipate this possibility.

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Get vaccinated!

I have highlighted previously how if SARS-2 becomes a significant public health problem in the US in the coming weeks, it will coincide with our influenza epidemic, which has been especially severe this year and might last until late in the spring. In addition, measles could return in 2020 just as it did in 2019. Back when measles occurred regularly in the U.S., it often peaked in late winter and early spring. We simply cannot ask our healthcare workers and state and local public health agencies to fight a triple epidemic of SARS-2, measles, and influenza over the coming weeks. It is therefore imperative that Americans get their families vaccinated against flu and measles.

State and local health agencies

If SARS-2 transmission becomes significant, many Americans believe the CDC will lead our nation’s response locally. The truth is that the CDC typically takes on an important advisory role, so that it would most likely fall to state and local public health departments to respond and manage these outbreaks. We have some outstanding state, county, city and local health departments, for instance our Harris County and Houston city health departments where I live and work. But we learned during the 2016 Zika outbreaks in Texas and Florida, that there can be tremendous variability in the staffing and expertise among different county and local health departments. Therefore, we’ll need to be ready to assist health departments lacking depth and breadth in their capacity for managing serious infectious disease epidemics.

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Should President Trump appoint a “SARS Czar?”

The President has put in place an outstanding team through our Department of Health and Human Service (DHHS) to fight this epidemic. I’ve met DHHS Secretary Azar previously and find him to be smart, committed and pragmatic. He has assembled an outstanding team of top public health physicians, including Drs. Robert Redfield and Nancy Messonnier at CDC. Previously, I also worked closely with Assistant Secretary of Health Brett Giroir when he led then-Governor Perry’s infectious disease task force to combat Ebola virus infection after it appeared in Dallas, Texas. And of course, Dr. Anthony Fauci is still at the helm at the National Institute of Allergy and Infectious Diseases of the U.S. National Institutes of Health. The point is that this is an “A-team” and Americans should feel very good about its ability to respond to SARS-2. However, we have also seen how serious and widespread epidemics can sometimes require the help of agencies outside of the health sector. The most obvious example occurred in 2014 when Ebola virus infection was decimating the West African countries of Guinea, Liberia and Sierra Leon. We ultimately needed to send in the 101st Army Airborne Division -- the “Screaming Eagles” -- to lead Operation United Assistance in order to provide a working health system to administer care and treatment. In addition, Ron Klain was appointed as “Ebola Czar” because of the complexity of our Ebola response, which involved numerous agencies of the federal government. He did an excellent job, and if SARS-2 becomes a significant public health threat in the U.S., our nation may require a similar coordinator to navigate activities across multiple federal agencies.

New Technologies

Finally, we are going to require improved biotechnologies to fight this epidemic. One of the problems faced by Chinese physicians was the lack of a sensitive and point-of-care diagnostic that could detect this virus in the early course of a patient’s illness. We’ll need such a diagnostic in order to give our nation’s healthcare workers the best chance to make good decisions on which patients require isolation during clinic visits or visits to hospital emergency rooms. We’ll need new antiviral drugs for severely ill patients, and we’ll need preventive vaccines, such as the ones we’re developing through support from the NIAID, NIH and other agencies. Through both the NIH and the creation of the Biomedical Advanced Research and Development Authority (BARDA), we have a running start on shaping these technologies. The U.S. hosts the finest research universities and institutes the world has ever seen, and I’m confident they will be up to the daunting task of accelerating new SARS-2 diagnostics, drugs and vaccines.

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