When I asked Collins what has surprised him most about the coronavirus from his perspective as a doctor and a scientist, he told me: “The degree to which this is so rapidly transmissible. More so than SARS was. SARS was a terribly scary situation for the world 18 years ago, but it never reached the level of infections or deaths that we have for this coronavirus, because it wasn’t as transmissible. SARS was transmissible but only from people who were really very sick. This one seems to be transmissible from people who have minor illness or maybe no illness at all—which is why it has been so difficult to get control or to know when you should be imposing these stringent measures we’ve been talking about. If you wait until you’ve seen lots of affected cases, you know you’ve waited too late, because the number of people who haven’t yet turned up in the health-care system but who are already infected is probably 100 times the number of cases you know about.”

Ken Harbaugh: The next, terrible phase of the crisis

What’s being done to help hospitals that are being overwhelmed, I asked Collins, and what about the issue of ventilators and protective gear?

“There’s a huge effort to try to prepare for that in terms of inventories of personal protective equipment, the so-called PPE; there is a national stockpile, and we’re trying to figure out how best to distribute that where it will be most needed,” he told me.

“Every hospital is looking at what their capabilities might be and what they might have to do in terms of setting up additional facilities nearby. With universities having closed up for students, it’s possible we may need to see university space used as spillover for patient care. There are lots of concerns about whether there are enough health-care professionals, especially in places that were already short on physicians, like in rural communities. There is a major effort organized through [Health and Human Services], but obviously a lot of it is going to come down to what happens at the community level. And a lot of it will depend upon whether we’re successful in flattening that curve so that the need for intense medical attention stretches out over the course of several months as opposed to hitting us all at once in the next few weeks.”

Because we don’t yet have a vaccine, and we don’t yet have therapeutics that we know work, the best means of trying to prevent what Collins says “could be a really terrible outcome,” in addition to social distancing, is using sanitizers and washing your hands faithfully with hot water and soap for 20 seconds as many times during the day as you possibly can. “Those all seem like medieval practices, but they work,” he told me.

The soonest a vaccine will be available is in a year to 18 months, despite “being developed in record time,” according to Collins, so that’s off the table for now. (One vaccine began phase 1 trials in 45 volunteers on Monday.) More encouragingly, he said, “I would hope that the therapeutic aspects—most notably with a drug called remdesivir, which is now in clinical trials in China, Japan, South Korea, and the U.S.—will show that that particular antiviral has considerable efficacy for people who are very sick. That would help a lot if we actually had a drug that could be offered to people who most need it.”