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Fighting COVID-19 Is Like 'Whack-A-Mole,' Says Writer Who Warned Of A Pandemic

Apr 1, 2020

Two years ago, science writer Ed Yong wrote an article for The Atlantic in which he warned that a new global pandemic was inevitable — and that the world would be unprepared for it when it arrived. Now, with the outbreak of COVID-19, much of what Yong warned about in his reporting has come true.

Yong says scientists are still working to understand how the novel coronavirus travels through air. His latest article for The Atlantic concerns whether or not people beyond health care workers and other front-line personnel should be wearing some sort of mask to help prevent spread of the coronavirus.

Yong notes that there are two ways in which respiratory viruses typically travel through air: as droplets of fluid and as evaporated specks of fluid called "aerosols."

Yong describes aerosols as "far-drifting" and "long-lasting" viral specks. "There is some growing evidence that aerosol transmission — what people would traditionally describe as being 'airborne' — does apply, to some extent, to the new coronavirus," he says.

He adds that it's not yet clear whether live infectious viral particles remain in the air where infected people have been: "That's the crucial thing to know," he says. "And then really, crucially, are there enough of those viral particles to actually start an infection? We don't know the answer to that yet."

Yong says the experts he has consulted have not come to a consensus regarding whether or not the general population should wear some sort of mask, when in public places. "There is a lot of movement towards recommending widespread mask usage from different countries," he says. "The CDC appears to be considering it. Health experts I've spoken to who were once dismissive about mask use are now edging towards recommending it."

But Yong adds that the short supply of N-95 respirator masks, and even professionally made surgical masks complicates matters.

"We're currently in a situation where masks are already running out in hospital settings and for health care workers, who are the people who need them the most. So any masks — any protective equipment — should go to health care workers as a matter of priority. And only then should we think about whether the general population should be considering wearing masks."

Looking ahead, Yong says that even if masks, frequent hand-washing and social isolation strategies are effective in slowing the virus' spread, the end to the pandemic is still a long way off: "We are in for this long, protracted game of whack-a-mole with the virus where different places will stamp it out at different times. It will surge back. It will need to be controlled again."


Interview Highlights

On what we know about how the virus travels through the air and how we're susceptible to inhaling it

There was one study that just shot virus-laden fluids into a rotating cylinder to create a cloud of aerosols. And they found that within that cloud, the virus remained stable for several hours, which suggests that it can at least survive in the air around us. Now, that's a pretty artificial setup. That's probably closer to a medically invasive procedure like intubation, rather than someone just breathing when they're walking down the street or sitting in a room. So it's hard to know what to make of that outside the health care setting.

But there are other studies that suggest that the coronavirus can be released into the air in less dramatic ways. For example, a new [study] released by the University of Nebraska Medical Center looked for traces of the virus' genetic material in the rooms of several patients who had COVID-19 — many of whom only had mild symptoms. So they found traces of that genetic material on lots of different surfaces, including hard to reach spots like ventilation grates and the floors beneath beds. That's consistent with the idea that the virus is moving through the air over distances longer than a droplet might land.

What we don't know is whether there are actually live infectious viral particles in the air. The presence of genetic material doesn't indicate that. It's like finding a fingerprint in a crime scene. It means that the culprit was once there, but they might have long gone. So that's the crucial thing to know. ... And, [in each case], are there enough of those viral particles to actually start an infection? We don't know the answer to that yet. And that's a really crucial piece of the puzzle.

On how thinking about masks for the general population might be changing

Confusion is completely understandable, because even among the experts who I've spoken to — including people who've studied airborne transmission and its possibility — opinion is divided on the role of masks and how much protection they can provide. There's just a mess of data on whether masks worn by the general population will provide protection against respiratory illnesses in general; whether masks prevent you, if you are infected, from infecting other people. I think that's a little clearer, both from the evidence and just through common sense. And that might matter a lot for a disease like COVID-19.

We know that the virus behind it can spread from one person to another before they show symptoms, and that is perhaps the strongest argument for widespread usage of masks. Even if you aren't currently coughing or sneezing or breaking into a fever, you might not know that you have a virus, and wearing a mask might stop you from spreading that virus to someone else.

On why touching your mask negates its protection

One of the reasons why some people are still on the fence about recommending widespread mask usage is this idea that people who wear masks and aren't used to them kind of futz around with them. They fidget with the masks, they touch their faces. There's not a huge amount of data on this ... but almost everyone I've spoken to who has experience of actually using the masks properly, whenever they've seen people use them in more casual ways, people almost always get it wrong. They pull the mask over their chin, wipe their faces. They touch the masks constantly. They're always adjusting it. And that carries a risk, and maybe the risk is that you do lure yourself into a false sense of security, thinking you're safe, but in a situation when you're actually increasing the likelihood of infection.

On how American hubris and exceptionalism have contributed to the slow response

[A virus] has no interest in people's terror, only their cells. It just wants hosts to infect and doesn't care whether you're feeling brave or not. And I think that some aspects of America's national character do seem to have made it harder for people to take the necessary measures to slow the spread of the pandemic. And not just this sense of resilience, of being brave in the face of fearful threats, but also the sense of individualism and exceptionalism. This idea that "I have the freedom to do what I want to do," which stops people from just staying indoors and heeding advice about isolating yourselves when it's necessary. And I think that the country's famed exceptionalism — the idea that this is the greatest country in the world — that, I think, contributed to a delay in the nation's response.

The [U.S.] could have sprung into action ready for this, for the virus to eventually reach it. But if anything, America more or less sat idle. It was sluggish. And I do wonder if that propensity to think of itself as being truly exceptional, that slight hubris, left it more unprepared than it needed to be. - Ed Yong

COVID-19 was taking off in China for at least a month before it first reached U.S. shores. And during that month, not much actually happened [in the U.S.]. A lot of preparedness measures could have been launched. The country could have sprung into action, ready for this, for the virus to eventually reach it. But if anything, America more or less sat idle. It was sluggish. And I do wonder if that propensity to think of itself as being truly exceptional, that slight hubris, left it more unprepared than it needed to be. And I think that even though many people had warned about this for a long time, the underwhelming nature of America's response to this threat has really surprised even people who had been warning, who had been issuing alarms.

There is a thing called the Global Health Security Index, which ranks different countries according to their levels of preparedness for pandemics, according to 140 different criteria, based on regulations from the World Health Organization. And out of all the countries that were assessed, the United States has the highest score — 83.5, a solid B. But if you look at how the country has actually reacted to the pandemic, I think we probably get something like an F. This nation that was meant to be the most prepared of all has really flubbed its response, and I think, to a degree, that has shocked even the most alarmed or pessimistic people who I'd spoken to before, in my earlier reporting.

On what happened to the medical supply chain for masks and swabs

The medical system runs on a just-in-time economy, much like the rest of the world, and products are made to order and they depend on these very long international supply chains, many of which have fractured in this pandemic. So, for example, Hubei Province, where the pandemic first took off in China, is also one of the world's leading centers for manufacturing medical masks. So the fact that the pandemic hit that region first and hardest really exacerbated the shortage of medical supplies. There's also now a shortage of the swabs that people used to collect viral samples as the very first step of testing. And one of the companies that leads the manufacture of those swabs is based in northern Italy, which is one of the centers of the pandemic in Europe. ...

It's really bad luck that both of those regions were particularly hit, but you could envisage the same problems for all sorts of other areas. I think this is what happens when you rely on a medical system that depends on these large international chains and that really don't have a lot of capacity to flex and surge in the event of a crisis. And that's especially bad now, because the pandemic has spread so quickly that the entire world is facing down the same problem at the same time and is after the same supplies at the same time — which really has stretched many of these supply chains to a breaking point. Everyone is after the same supplies and there aren't enough of those supplies to go around. Everyone is competing with each other instead of cooperating, because the crisis has spread so quickly.

On rolling out a COVID-19 vaccine

The first steps so far have actually been encouragingly quick. A vaccine candidate has already entered early safety trials after a record-breakingly short time from actually identifying and sequencing the genome of this new virus. But the journey from these first trials to actually having a product that you can shoot into people's arms is very long and hard to shortcut. You need to know whether the vaccine is safe, whether it triggers an immune reaction. Then you need to know whether it's actually effective at preventing infections. You need to know what dose to use, how many doses to use, whether it also works in elderly people who are more at risk. All of these steps take time, and if you don't go through them, you might run the risk of creating a product that has really severe side effects or that is rolled out widely but just doesn't work.

So the experts I've spoken to feel that it will probably take between 12 and 18 months to even develop a working vaccine, let alone then to create the manufacturing capacity to create enough doses and then to distribute those doses and to actually inject them into people. This is not going to be a fast process. And until that process is complete, COVID-19 is going to be a part of our lives.

On the different methods being used to develop a vaccine for COVID-19

Most existing vaccines [against other viruses] use a dead or weakened virus or a fragment of that virus. So the idea is, you show that to the immune system, [and] the immune system can prepare defenses ahead of time. [One new vaccine candidate in development against the coronavirus] works in a slightly different way. It uses a piece of the virus' genetic material, its RNA. You inject that up into a person in the hope that that person then can build their own fragments of the virus using the instructions in that genetic material and that those sorts of homegrown fragments can then train the immune system. These RNA vaccines are a new technology. They have the potential to be really important and to be much faster. But the caveat is that no such vaccines have ever been taken to the market before. So we're breaking new ground and there aren't facilities already available that can manufacture such vaccines in the quantities that are needed.

By contrast, other teams are using more traditional approaches. For example, there's one group in France that is trying to repurpose the existing measles vaccine to instead target the new coronavirus. That might take a longer time at the front end. But on the plus side, if that actually works, then the world knows how to make measles vaccines in large quantities. So it's unclear which of ... these solutions will end up being quickest. But it's certainly reassuring that a lot of different options are being tried — not just these two, but but many others. And we'll just have to wait and see which gets to the finish line soonest.

On the idea that the spread of the coronavirus might slow down in the summer

So, traditionally, coronaviruses and a lot of other respiratory viruses, like flu, do go away in the summer, and there are many possible reasons for that. Certainly, humidity and heat makes it easier for the cells of our airways to clear out a virus, and some of the immune response to these respiratory viruses appear to be stronger under those climatic conditions.

Now, is this new coronavirus going to behave in the same way? Possibly. Is that going to make a difference with the pandemic? I'm not sure. And the reason for that is that the virus is circulating through a global population that is completely immunologically naive to it. Our immune systems are not ready to deal with something like this. And so the virus has a large proportion of hosts among whom it can easily spread. To hope that the summer is going to downplay those dynamics far enough to contain the pandemic is, I think, wishful thinking. ... We're seeing transmission in places like Australia, which is just coming out of its summer, or Singapore, which is hot and humid in the tropics. And what that tells us is that it's probably wishful thinking to hope for heat and humidity to be the things that contain this virus. They may help, but only if we can slow its spread in other ways, such as through social distancing.

On being prepared for COVID-19 to come back

I think that's very likely. I think most experts would expect some kind of resurgence once current social distancing measures are released. That's sort of in the nature of these viruses. It's definitely likely because the pandemic is now so widespread that unless the entire world simultaneously brings the virus to heel, there are always going to be pockets where outbreaks are still ongoing, and that can seed [and] can reignite sparks of infection in places where outbreaks had already been extinguished. ...

And so we're likely looking at multiple rounds of social distancing, multiple bouts of social upheaval. Now, it's possible if we get our act together and if we do well in this first wave, that those subsequent bouts will be less dramatic and less uprooting than this current period of time has been, and that may well just be because of that uneven spread. So currently the virus is everywhere. It's hitting everywhere ... at more or less the same time. If different places can get it under control, there might be less potential for that sort of explosive worldwide spread. And then, over time, one would hope that surveillance measures would be better. We become better at testing for the virus and working out who's immune to it, at building up the necessary supplies to protect health care workers. All of those measures might mean that we can get a little bit more sophisticated in where social distancing is being rolled out, in the nature of those measures. But I think it's very clear that that is going to be a long game.

Pandemics often expose existing fault lines in societies, and they reveal whom a society cares about and whom it often ignores. - Ed Yong

On how the pandemic has hit society's most vulnerable

Clearly, the economic implications of this are going to be profound. I think, as with many disasters, it's going to hit people in different ways that are magnified by existing inequalities; people from low income groups, people from marginalized groups are going to feel the effects of this far more.

Pandemics often expose existing fault lines in societies, and they reveal whom a society cares about and whom it often ignores. The people who are still having to serve on the front lines of society while everyone else is sheltering indoors, people like grocery store workers, janitors, they are currently risking their lives because many of them don't have a choice. The elderly who have often been marginalized in the fringes of society are now [being asked to] isolate themselves even more, deepening the loneliness that many of them have already felt. People with mental health disorders, people with anxiety and obsessive compulsive disorder who have long been grappling with worries about infection and cleanliness, are now seeing some of their worst nightmares playing out around them and are struggling in a context where they don't have access to their usual support networks or therapists.

So a lot of societal dynamics which were already being overlooked and which were already fraying are going to fray even more. I think it's important to be wary of [that unraveling] and to look out for the people who are most going to need help. A pandemic causes a wave of physical suffering, but following that, there is also economic suffering, mental suffering, emotional suffering. We will need to be wary of all of those things when society rebuilds in the wake of this crisis.

On the potential of the pandemic to inspire positive change

I think that this is the time to be imagining what a better world might look like and to start actively working towards it. These periods of great social upheaval carry with them great risk and tragedy, but also great potential. So on a very simple level, after HIV spread throughout the world and the '80s, it led to better awareness of sexual health that led to mainstreaming of condom use, of testing [for sexually transmitted infections]. And perhaps the COVID-19 pandemic will lead to a normalization of health behaviors that have been quite difficult to get people to take up, like regular hand-washing for 20 seconds — sometimes a rarity even in hospital settings, let alone in homes. And now all of us — well, many of us, hopefully — [are] washing our hands on a regular basis every day. Hopefully that will become a normal part of our culture in the future.

I also really hope that a lot of the ethic of cooperation that we're starting to see, of people in communities looking out for each other, coming together at a moment of crisis, will continue through the rest of this long-haul pandemic and beyond. I think we're going to need that if we're going to be better-prepared for what's to come. We need that sense of cooperation between neighbors in a community, between states, in a country and between countries — an international community.

Amy Salit and Seth Kelley produced and edited the audio of this interview. Bridget Bentz, Molly Seavy-Nesper and Deborah Franklin adapted it for the Web.

Copyright 2020 Fresh Air. To see more, visit Fresh Air.

TERRY GROSS, HOST:

This is FRESH AIR. I'm Terry Gross.

My guest Ed Yong has been covering the pandemic for The Atlantic magazine, where he's a science writer. Two years ago, he wrote an article about why a new plague was inevitable and why we would be unprepared. Now that so much of what he warned about in his reporting has come true, he's been covering how and why we failed to stop the spread of COVID-19, why this virus has been so successful in spreading, how the pandemic might end, what the aftermath might be and why this is a truly modern pandemic. He's also keeping up with the latest on how to stay safe. Ed Yong is speaking to us by Skype from Washington, D.C.

Ed Yong, welcome back to FRESH AIR. So since as we speak, you are writing an article about how airborne is this virus, do we need to wear masks - so let me just ask you about that first because we're also concerned about how do we stay safe. So what is the latest you've learned about how the virus travels through the air and how susceptible we are to inhaling it?

ED YONG: So when people who are infected with respiratory viruses talk or breathe or cough, they're releasing viral particles and little globs of fluid. And if those globs are very small, then they evaporate quickly, and the dried-out viruses drift over longer distances and linger in the air. That's called aerosols. If the globs are very big, then they splash down close to the person before they can evaporate, and those are called droplets. When people talk about a virus being airborne, they're really talking about aerosols, those far-drifting, long-lasting viral specks in the air.

When the World Health Organization asserts that the coronavirus is not airborne, it's really talking about those droplets which land close to a person and which either have to land directly on your face to start an infection or to be carried over by unwashed hands that touch contaminated surfaces. You know, in both cases, the viruses are moving through the air, but what really matters is how far they move and their likelihood of getting into your own respiratory tract.

Now, there is some evidence that - there is some growing evidence that those - that aerosol transmission, what people would traditionally describe as being airborne, does apply to some extent to the new coronavirus. For example, there was one study that just shot virus-laden fluids into a rotating cylinder to create a cloud of aerosols. And they found that within that cloud, the virus remained stable for several hours, which suggests that it can at least survive in the air around us. Now, that's a pretty artificial set up. That's probably closer to a medically invasive procedure, like intubation, rather than, you know, someone just breathing when they're walking down the street or sitting in a room. So it's hard to know what to make of that outside the health care setting.

But there are other studies that suggest that the coronavirus can be released into the air in less dramatic ways. For example, a new one released by the University of Nebraska Medical Center looked at - looked for traces of the virus' genetic material in the rooms of several patients who had COVID-19, many of whom only had mild symptoms. So they found traces of that genetic material on lots of different surfaces, including hard-to-reach spots like ventilation grates and the floors beneath beds. That's consistent with the idea that the virus is moving through the air, over distances longer than a droplet might land.

What we don't know is whether there are actually live infectious viral particles in the air. The presence of genetic material doesn't indicate that. It's like finding a fingerprint in a crime scene; it means that the culprit was once there, but they might have long gone. So that's the crucial thing to know - are their live infectious viruses in air samples where infected people have been? And then really crucially, are there enough of those viral particles to actually start an infection? We don't know the answer to that yet, and that's a really crucial piece of the puzzle.

GROSS: It seems like the advice about masks is starting to shift. Initially, it was you don't need a mask. Then it was, like, you should wear a mask because you might infect somebody if you sneeze or cough. And now it's - I've been starting to see, you should just wear a mask. And I have no idea and I'm sure a lot of our listeners have no idea which of these alternatives is the most accurate one, the most reliable one.

YONG: Yeah. And, you know, what I'd say to that is confusion is completely understandable because even among the experts who I've spoken to, including people who've studied airborne transmission and its possibility, opinion is divided on the role of masks and how much protection they can provide. There's just a mess of data on whether masks worn by the general population will provide protection against respiratory illnesses in general.

Whether masks prevent you, if you are infected, from infecting other people, I think that's a little clearer both from the evidence and just through common sense. And that might matter a lot for a disease like COVID-19. We know that the virus behind it can spread from one person to another before they show symptoms, and that is perhaps the strongest argument for widespread usage of masks, even if you aren't currently coughing or sneezing or breaking into a fever. You might not know that you have a virus, and wearing a mask might stop you from spreading that virus to someone else.

One of the reasons why some people are still on the fence about recommending widespread mask usage is this idea that people who wear masks and aren't used to them kind of futz around with them. You know, they fidget with the masks. They touch their faces. There's not a huge amount of data on this, actually. There are not a ton of studies that actually back this up. But almost everyone I've spoken to who has experience of actually using the masks properly, whenever they've seen people use them in more casual ways, people almost always get them - get it wrong. They pull the mask down over their chin, wipe their faces. They touch the masks constantly. They're always adjusting it. And that carries a risk. And maybe the risk is that you lure yourself into a false sense of security, thinking you're safe but in a situation when you're actually increasing the likelihood of infection.

But I think that there is a lot of movement towards recommending widespread mask usage from different countries. The CDC appears to be considering it. Health experts I've spoken to who were once dismissive about mask use are now edging towards recommending it. The one caveat to all of this is that this would be an easier debate in an ideal world in which masks were in plentiful supply, and this is not that world. We're currently in a situation where masks are already running out in hospital settings and for health care workers who are the people who need them the most. So any masks, any protective equipment should go to health care workers as a matter of priority, and only then should we think about whether the general population should be considering wearing masks.

GROSS: You know, I want to just get to a point that you raised that I thought was very interesting, which is that after 9/11, Americans learned to be proud of carrying on as normally as possible in spite of their fear because if we stopped behaving normally, the terrorists would have won. But a virus is completely different. With a virus, you really have to change your behavior. You have to be super cautious. And I really think that's such an interesting mind shift that I hadn't quite heard expressed before.

YONG: Yeah. You know, like I said in the piece, that SARS-CoV-2 has no interest in people's terror, only their cells. It just wants hosts to infect and doesn't care whether you're feeling brave or not.

And I think that some aspects of America's national character do seem to have made it harder for people to take the necessary measures to slow the spread of the pandemic and not just this sense of - you know, of resilience, of being brave in the face of fearful threats, but also the sense of individualism and exceptionalism, this idea that I will do - I have the freedom to do what I want to do, which stops people from just staying indoors and heeding advice about isolating yourselves when it's necessary. And I think that the country's famed exceptionalism, the idea that this is the greatest country in the world, that it's - you know, and that, I think, contributed to a delay in the nation's response.

COVID-19 was taking off in China for at least a month before it first reached U.S. shores, and during that month, not much actually happened. A lot of preparedness measures could have been launched. The country could have sprung into action, ready for this - for the virus to eventually reach it. But if anything, America more or less sat idle. It was sluggish. And I do wonder if that propensity to think of itself as being truly exceptional, that slight hubris, left it more unprepared than it needed to be.

And I think that even though many people had warned about this for a long time, the underwhelming nature of America's response to this threat has really surprised even people who had been warning, who have been issuing alarms. There is a thing called the Global Health Security Index, which ranks different countries according to their levels of preparedness for pandemics, according to 140 different criteria based on regulations from the World Health Organization. And out of all the countries that were assessed, the United States has the highest score - 83.5, a solid B. But if you look at how the country has actually reacted to the pandemic, I think we probably get something like an F.

This nation that was meant to be the most prepared of all has really flubbed its response and I think in - to a degree that has shocked even the most alarmed or pessimistic people who I'd spoken to before in my earlier reporting.

GROSS: Let me reintroduce you. If you're just joining us, my guest is Ed Yong, a science writer for The Atlantic who's been writing about COVID-19. We'll be right back after we take a short break. This is FRESH AIR.

(SOUNDBITE OF NOAM WIESENBERG'S "DAVKA")

GROSS: This is FRESH AIR. Let's get back to my interview with Ed Yong, a science writer for The Atlantic who's been writing about COVID-19. Two years ago in an article titled "Is America Ready For The Coming Plague," he more or less predicted the current epidemic, the reasons why it was inevitable and why we would not be prepared. One of his recent articles is about possible scenarios for how the pandemic might end and what the aftermath might be.

One of the problems we're facing is that there aren't enough masks. There's not enough protective equipment in general for doctors and nurses. There aren't masks for citizens who, you know, want to use them. There aren't enough respirators. There are shortages of other things. And you say that part of the reason why is the Byzantine global supply chain. What are some of the things that have gone wrong in the supply chain or that just, like, don't work about the supply chain in a time of a pandemic like this?

YONG: Yeah, so the medical system runs on a just-in-time economy, much like the rest of the world. And products are made to order, and they depend on these very long international supply chains, many of which have fractured in this pandemic. So for example, Hubei province, where the pandemic first took off in China, is also one of the world's leading centers for manufacturing medical masks. So the fact that the pandemic hit that region first and hardest really led - really exacerbated the shortage of medical supplies. So there's also now a shortage of the swabs that people use to collect viral samples as the very first step of testing. And one of the companies that manufactures the - that leads the manufacture of those swabs is based in northern Italy, which is one of the centers of the pandemic in Europe.

These problems are certainly unfortunate. It's really bad luck that both of those regions were particularly hit. But you could envisage the same problems for all sorts of other areas. I think this is what happens when you rely on a medical system that depends on these large international chains and that really don't have a lot of capacity to flex and surge in the event of a crisis. And that's especially bad now because the pandemic has spread so quickly that the entire world is facing down the same problem at the same time and is after the same supplies at the same time, which really have stretched many of these supply chains to breaking point. Everyone is after the same supplies, and there aren't enough of those supplies to go around. Everyone is being - is competing with each other instead of cooperating because the crisis has spread so quickly.

GROSS: What is the alternative to a decentralized hospital system?

YONG: I think what we need now is better centralized coordination at the federal level. So one possible way of doing that is to tap in a large logistics agency that is capable of coordinating the nationwide deployment of tests and supplies that is currently needed. One option is the Defense Logistics Agency, which coordinates military operations overseas. They're very experienced in logistics, and they have helped in previous crises like the - like America's response to the 2014 Ebola outbreak. I mean, it doesn't have to be them, but there definitely does need to be some kind of centralized coordinated leadership to ensure that supplies and testing kits are manufactured to the level we need them and that they are distributed equally and equitably across the country.

GROSS: You've written about why creating a vaccine for this virus is so difficult and that vaccines in general, like flu vaccines, viral vaccines in general, have not been considered very profitable for pharmaceutical companies. Why aren't they considered profitable when the flu comes around every year and so many people get flu shots?

YONG: So the flu is actually an interesting exception in that there is a consistent annual market for that and a large industry that knows how to make flu vaccines. If this were a flu pandemic, we would actually be in better stead because current vaccine infrastructure could easily be repurposed to dealing with whatever new strain was circulating around the world. As it is, it's not a flu vaccine; it's a coronavirus. There are no existing vaccines for that because such viruses were either deemed to be very mild. There are several that cause common cold-like conditions or to be very rare, as in the case with the original SARS virus or MERS.

So there wasn't a ton of impetus to create new vaccines, which means that currently we have to start from scratch. And the process of vaccine development is very long. The first steps so far have actually been encouragingly quick. A vaccine candidate has already entered early safety trials after a record-breakingly (ph) short time from actually identifying and sequencing the genome of this new virus. But this - the journey from these first trials to actually having a product that you can shoot into people's arms is very long and hard to shortcut. You need to know whether the vaccine is safe, whether it triggers an immune reaction. Then you need to know whether it's actually effective at preventing infections. You need to know what dose to use, how many doses to use, whether it also works in elderly people who are more at risk.

All of these steps take time, and if you don't go through them, you might run the risk of a product - of creating a product that has really severe side effects or that is rolled out widely but just doesn't work. So the experts I've spoken to feel that it will probably take between 12 and 18 months to even develop a working vaccine, let alone then to create the manufacturing capacity to create enough doses and then to distribute those doses and to actually inject them into people. This is not going to be a fast process. And until that process is complete, COVID-19 is going to be a part of our lives.

GROSS: If you're just joining us, my guest is Ed Yong. He's a science writer for The Atlantic who has been writing about COVID-19. We're going to take a short break, and then we'll be right back. I'm Terry Gross, and this is FRESH AIR.

(SOUNDBITE OF REVERSO'S "BLUE FEATHER")

GROSS: This is FRESH AIR. I'm Terry Gross. Let's get back to my interview with Ed Yong, a science writer for The Atlantic. He's been writing about COVID-19, including why we were so unprepared, why it's so difficult to create a vaccine, ways the pandemic might end and what the aftermath might be. When we left off, he was talking about a vaccine candidate that has entered trials in record-breaking short time, but the journey to actually having a product is long and hard to shortcut.

So the vaccine that you're referring to that's a candidate that's being tested now, that vaccine is taking a different approach than existing vaccines. What's the difference?

YONG: So most existing vaccines use a dead or weakened virus or a fragment of that virus. So the idea is you show that to the immune system, the immune system can prepare defenses ahead of time. This new vaccine works in a slightly different way. It uses a piece of the virus' genetic material, its RNA. You inject that into a person in the hope that that person then can build their own fragments of the virus using the instructions in that genetic material and that those sort of homegrown fragments can then train the immune system.

These RNA vaccines are a new technology. They have the potential to be really important and to be much faster, but the caveat is that no such vaccines have ever been taken to the market before. So we're sort of treading - we're breaking new ground. And there aren't facilities already available that can manufacture such vaccines in the quantities that are needed. By contrast, other teams are using more traditional approaches. For example, there's one group in France that is trying to repurpose the existing measles vaccine to instead target the new coronavirus. That might take a longer time at the front end, but on the plus side, if that actually works, then there are all - the world knows how to make measles vaccines in large quantities.

So it's unclear which of these solutions will end up being quickest, but it's certainly reassuring that a lot of different options are being tried, not just these two but many others. And we'll just have to wait and see which gets to the finish line soonest.

GROSS: Let's talk about some of the endgame scenarios you've written about, ways in which this pandemic might end. A lot of people are hoping that, like the flu, this virus will subside in the summer, and even if it comes back in the fall, the way the 1918 flu pandemic did, it will give us time to prepare better, to get more resources, to get more PPEs. Why might a virus like this subside in the summer? What is it about summer?

YONG: So traditionally, coronaviruses and a lot of other respiratory viruses, like flu, do go away in the summer and that - there are many possible reasons for that. Certainly, humidity and heat makes it easier for the cells of our airways to clear out a virus, and some of the immune response to these respiratory viruses appear to be stronger under those climatic conditions.

Now, is this new coronavirus going to behave in the same way? Possibly. Is that going to make a difference for the pandemic? I'm not sure. And the reason for that is that the virus is circulating through a global population that is completely immunologically naive to it. Our immune systems are not ready to deal with something like this, and so the virus has a large proportion of hosts among whom it can easily spread. To hope that the summer is going to downplay those dynamics far enough to contain the pandemic is, I think, wishful thinking.

GROSS: So it's already summer in the Southern Hemisphere. What are we seeing there?

YONG: So we're seeing transmission in places like Australia, which is just coming out of its summer, or Singapore, which is hot and humid in the tropics. And what that tells us is that it's probably wishful thinking to hope for heat and humidity to be the things that contain this virus. They may help, but only if we can slow its spread in other ways, such as through social distancing.

GROSS: So in terms of the endgame, one scenario is that the virus subsides for periods because of social distancing or because of summer and then it comes back again. So we have to be prepared - even if it seems like the virus is receding, we have to be prepared for it coming back again. Do you think that's a very likely scenario?

YONG: I think that's very likely. I think most experts would expect some kind of resurgence once current social distancing measures are released. That's sort of in the nature of these viruses. It's definitely likely because the pandemic is now so widespread that unless the entire world simultaneously brings the virus to heel, there are always going to be pockets where outbreaks are still ongoing and that can seed - that can reignite sparks of infection in places where outbreaks had already been extinguished.

So we are in for this long, protracted game of whack-a-mole with the virus, where different places will stamp it out at different times. It will surge back. It will need to be controlled again. And so we're likely looking at multiple rounds of social distancing, multiple bouts of social upheaval. Now, it's possible, if we get our act together and if we do well in this first wave, that those subsequent bouts will be less dramatic and less uprooting than this current period of time has been. And that may well just be because of that uneven spread.

So currently, the virus is everywhere. It's hitting everywhere at more or less the same time. If different places can get it under control, there might be less potential for that sort of explosive worldwide spread. And then over time, one would hope that surveillance measures would be better. We would become better at testing for the virus, at working out who is immune to it, at building up the necessary supplies to protect health care workers. All of those measures might mean that we can get a little bit more sophisticated in where social distancing is being rolled out and the nature of those measures. But I think it's very clear that that is going to be a long game.

GROSS: So there are hopes for a test that tests people's immunity to the virus. How does a test like that figure into the larger scenario of how this epidemic might end?

YONG: So this is really important. When people are exposed to the virus, they develop antibodies that recognize it and that provide them, hopefully, with some degree of protection, of immunity to the disease. Now, a test that looks for those antibodies, a so-called serological test would first give us a greater sense of how many people actually have been infected, which is something we still don't know. But also, it would give us a sense of who might be protected from the virus going forward. That's still something that I think scientists need to confirm. They need to confirm that someone with antibodies genuinely is immune, that they can - that they won't be infected by the virus again and especially that they can't transmit the virus to someone else.

But if all that pans out, then these kinds of tests will be a really important part of our arsenal against COVID-19. They might allow, for example, people who know that they're immune to return to the workforce or to care for sick people or to sort of help keep society and the economy running during periods of social distancing. One of the big unanswered questions, however, is how long immunity would last. So against the milder coronaviruses that cause common colds, immunity only lasts for less than a year. Against the most severe ones like SARS, it lasts for much longer, and it might be reasonable to expect that for SARS-CoV-2, the new coronavirus, the immunity would be somewhere in the middle.

So it's unlikely that people would get lifelong protection like they would against, say, measles or chicken pox. But if they can retain immunity for a couple of years, that would certainly make a difference. It might mean that they might need to get revaccinated every couple of years. It might mean that COVID-19 epidemics might be a recurring feature, if not an annual one. But having that information will certainly allow us to plan for the future.

GROSS: Let me reintroduce you here. If you're just joining us, my guest is Ed Yong, a science writer for The Atlantic who's been writing about COVID-19. We'll be back after a short break. This is FRESH AIR.

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GROSS: This is FRESH AIR. Let's get back to my interview with Ed Yong, a science writer for The Atlantic who's been writing about COVID-19.

You've also written about the aftermath of this pandemic. So let's talk about that a little bit. You see society likely changing in several ways as a result of this pandemic. And of course, economically, health care - you see inequality increasing economically and in health care because of the virus.

YONG: Yeah, absolutely. Clearly, the economic implications of this are going to be profound. And I think, as with many disasters, it's going to hit people in different ways that are magnified by an - by existing inequalities. People from low-income groups, people from marginalized groups are going to feel the effects of this far more. Pandemics often expose existing fault lines in societies, and they reveal whom a society cares about and whom it often ignores.

So people like - the people who are still having to serve on the front lines of society while everyone else is sheltering indoors - people like grocery store workers, janitors - they are currently risking their lives because many of them don't have a choice. The elderly, who have often been marginalized in the fringes of society, are now asking to isolate themselves even more, deepening the loneliness that many of them have already felt. People with mental health disorders, people with anxiety and obsessive compulsive disorder who have long been grappling with worries about infection and cleanliness are now seeing some of their worst nightmares playing out around them and are struggling in a context where they don't have access to their usual support networks or therapists.

So a lot of societal dynamics which were already being overlooked and which were already fraying are going to fray even more. I think it's important to be wary of them and to look out for the people who are most going to need help. A pandemic causes a wave of physical suffering, but following that, there's also economic suffering, mental suffering, emotional suffering. We will need to be wary of all of those things when society rebuilds in the wake of this crisis.

GROSS: I know you've been thinking a lot about children who are growing up in this pandemic.

YONG: Yeah. My colleague Vann Newkirk wrote an incredible piece for The Atlantic about the costs to children. People - you know, children, I think we think of them as being incredibly resilient. And to an extent, they are, but they are also vulnerable to large changes in the world. They're sensitive to those changes. And people who grow up at a time of emotional trauma and great societal upheaval might bear the scars of those changes well into adulthood. And it is important to be mindful and wary of that.

GROSS: You also see the potential for some things changing for the better when the pandemic ends.

YONG: Absolutely. You know, I think that this is the time to be imagining what a better world might look like and to start actively working towards it. These periods of great social upheaval carry with them great risk and tragedy but also great potential. So on a very simple level, after HIV spread throughout the world in the '80s, it led to better awareness of sexual health. It led to mainstreaming of condom use, of STI testing.

And perhaps the COVID-19 pandemic will lead to a normalization of health behaviors that have been quite difficult to get people to take up, like regular hand-washing for 20 seconds, sometimes a rarity even in hospital settings, let alone in homes. And now all of us - well, many of us are hopefully washing our hands on a regular basis every day. Hopefully, that will become a normal part of our culture in the future.

I also really hope that a lot of the ethic of cooperation that we're starting to see, of people in communities looking out for each other, of coming together at a moment of crisis will continue through the rest of this long-haul pandemic and beyond. I think we're going to need that if we're going to be better prepared for what's to come. We need that sense of cooperation between neighbors and a community, between states and a country and between countries and an international community.

GROSS: You're British, and I don't know how much attention you've been paying to the news out of England. But before Boris Johnson contracted the virus himself, he made quite a show of shaking hands with a lot of people, you know, to demonstrate his lack of fear. And then he got the virus. And do you know what impact that's had on people in England, seeing that happen? And I also - I haven't heard anything about how his health is since contracting the virus.

YONG: I haven't, either. And I think the biggest problem with the U.K.'s response to this pandemic has been - I think some of it's communication. Early on, some of its experts were talking about pursuing herd immunity as a strategy, which led to people rightly worrying that lives were going to be sacrificed in kind of a cavalier way as the government was going to pursue this bizarre strategy of allowing people to get infected. They then turned back on that and argued that that wasn't what they were going for, even though the messaging was incredibly confusing. They initially went for a softly-softly approach to social distancing and then eventually put in much stronger measures as some of the scientists that they were consulting updated their models and came to more dire conclusions.

It harkens back to what we talked about with the U.S. at the start of this interview, that a lot of the world's great powers seem to have been caught unawares in their response to this virus in ways that sort of reek of arrogance and hubris, of thinking themselves better able and being sort of smarter and readier than other countries. And if you look at places that have done really well in this pandemic, places like Hong Kong and Taiwan and Singapore, one of the things that unites them is that they've had experience with similar diseases, like the original SARS back in 2003. And I think that led to a sort of public consciousness about what these kinds of viruses can do to a society, and that better prepared them for leaping into action now. And countries that didn't have that experience, like the U.S. and the U.K., just sort of lacked that imagination.

And that's not going to be a problem going forward, I think, and maybe that's one of the more positive outcomes that will lead us to be better prepared in the future - a sense of collective humility in the face of what these diseases are capable of.

GROSS: Let me reintroduce you here. My guest is Ed Yong. He's a science writer for The Atlantic who's been writing about COVID-19. We'll be right back after a break. This is FRESH AIR.

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GROSS: This is FRESH AIR. And if you're just joining us, my guest is Ed Yong, a science writer for The Atlantic who's been writing about the pandemic.

As a science writer, somebody who, like, studies science and talks to the science experts, you're not a political writer; you're a science writer. But politics has driven in so many ways how we have dealt with the epidemic - for example, when President Trump and other people on the right were calling this a liberal hoax; when Trump thought, like, hey, you know, I did what I needed to do. I'll close the door to China. That was great. We're kind of done. He's in combat with the press, who we're all relying on to give us good information. As a science writer looking at how politics has been driving some of the response in the U.S., what does it make you think about?

YONG: I think science and politics are inextricable when it comes to being prepared for something like this. We need the best possible information. We need clear, evidence-based thinking from our leaders in order to cope with a crisis like this. And I think, sadly, we are not getting it.

Some of the misinformation is incredibly basic. Trump has said in the press room that this could be flu, that we don't really know what it is. In fact, that's one of the only things we absolutely know. We know that this is a coronavirus, and we know that it is not the flu. You know, he has touted unproven medications that have caused people to, you know, pursue their own treatments, sometimes with devastating consequences. He has repeatedly - in the early stages of the pandemic, he repeatedly downplayed the possibility that this could be a problem for the U.S., even as the virus was spreading and even as case numbers were growing.

This is not helpful behavior. Regardless of your political leanings, I think we can all agree that we want our leaders to be on top of this, and we want them to - you know, I am rooting for the country to succeed. I want the federal government to get its act together and to provide information that people can rely on. I am not American, but my friends and family are here, and they depend on that response. And it's too chaotic. It is too often misleading, and that absolutely needs to change.

The worrying thing to me is that red and blue America are getting very different views of this pandemic. People who support the president are more likely to take this less seriously, more - less likely to adhere to social distancing measures, and I think that is going to cost not only the country but them specifically, and I think that's a huge tragedy. We need everyone to be banding together at this moment and not being divided. And I think, uniquely, this is a situation where the line between mistruth and misinformation and its consequences is going to be very, very short.

You know, someone can get up in the press room and make bold claims about jobs, the economy, and the truth of those statements might not be known for months and might even then be hard to pass. But if you get up there and you say, everyone can get testing - which the administration has said - and then the next day everyone cannot get testing because it's not available, it becomes very obvious that you've said something that's not true. If you tell people that this isn't a problem or that this is a hoax and their friends and family fall sick, it's obvious that you've not said something right.

And a pandemic is a very democratizing thing. You know, people whose power and privilege would once have shielded them from the consequences of bad policy are now suffering from lung failure. You know, senators are getting sick. And I wonder if that immediacy and the powerful widespread nature of this disease might be a factor that eventually breaks down that partisan divide and actually shows everyone the reality of what is happening. And I hope that that doesn't come too late.

GROSS: Ed Yong, thank you so much for talking with us. Thank you for your reporting. I wish you and your family good health.

YONG: Thank you so much. I hope you stay safe, too.

GROSS: Ed Yong is a science writer for The Atlantic. Tomorrow on FRESH AIR, our postponed interview with Dr. David Nott, a world-renowned trauma surgeon who's worked in war zones around the globe and is now battling the pandemic, treating patients with COVID-19 in his home country, England. He's applying some of what he learned working in other people's wars and disasters. Nott has written a new memoir called "War Doctor." I hope you'll join us.

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GROSS: FRESH AIR's executive producer is Danny Miller. Our interviews and reviews are produced and edited by Amy Salit, Phyllis Myers, Sam Briger, Lauren Krenzel, Heidi Saman, Therese Madden, Mooj Zadie, Thea Chaloner and Seth Kelley. Our associate producer of digital media is Molly Seavy-Nesper. Our technical director and engineer is Audrey Bentham. Roberta Shorrock directs the show. I'm Terry Gross.

(SOUNDBITE OF KEN PEPLOWSKI'S "CAROLINE, NO") Transcript provided by NPR, Copyright NPR.