Dr. John Swartzberg (Courtesy Swartzberg); 3d print of the Novel Coronavirus (National Institute of Allergy and Infectious Diseases/Flickr CC BA 2.0)
Dr. John Swartzberg (Courtesy Swartzberg); 3d print of the Novel Coronavirus (National Institute of Allergy and Infectious Diseases/Flickr CC BA 2.0)

UC infectious disease expert on coronavirus: ‘A lot of questions, very few answers’

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As the coronavirus threat continues to grow, public health officials are offering advice to mitigate risks. Dr. John Swartzberg, an infectious disease specialist with the UC Berkeley-UCSF Joint Medical Program (a program he formerly directed), said in an interview with J. on March 2 that while the virus is something to be concerned about, people should also maintain perspective.

J.: If you were in charge of a place where many people congregated, such as a synagogue or a school, what sorts of precautions would you take?

Dr. John Swartzberg: If things continue to progress, which I think they’re going to, one of the first things people can do is social distancing from places where people congregate. That would include synagogues. At UC Berkeley, we’re making contingency plans. If things get a lot worse, we’re going to try and do a lot of virtual teaching.

Is it true that masks aren’t something that you should be buying? That you should just wash your hands? What other measures should we be taking?

Masks will not protect you against getting infected. What they are good for is for people who are infected so that they don’t spread droplets to other people. The only thing I can argue for using a mask is it keeps your hands away from your mouth and nose.

I’m recommending the standard public health fare. Lots of hand-washing. If you don’t have soap and water, a good alternative is alcohol rubs. And don’t touch your face.

In terms of social distancing, I think people have to start thinking about circumstances they could put themselves in or that would put them at risk for contracting this infection. The major places would be crowds. You may not have a choice in terms of having to take mass transit, because you have to get to work, for example. But you may have a choice in terms of going to a concert where there’s thousands of people, or you may have a choice to not use airplanes at this period in time.

For example, every year my wife and I go back to visit my daughter and her family in D.C. over spring break. This year, we decided not to take the risk of flying because we didn’t have to.

The virus is deadlier for the elderly. Is there anything extra that older people should be doing, or anything specific?

They’d be the same precautions, but just follow them more closely or carefully. So a lot of what went into my wife’s and my decision to not travel back East in three weeks had to do with the fact that we’re over 65. If I was young, frankly, I don’t think I would fly unless I had to right now.

What’s the biggest misconception right now that people have about coronavirus?

I think that people’s fear is likely out of proportion to the severity of what this will be. People need to keep in mind that we are much more fearful of the unknown than the known, even when the known is maybe much more serious.

Somehow, people aren’t worried that 18,000 Americans are dead [this flu season, which began in October] from influenza, and they’re terrified over something that’s killed less than 10 people [at the time of this interview] in the United States so far.

It is something serious. It’s something to be very concerned about. It’s something for public health to be very aggressive about in terms of protecting the population. All of those things are real and true, and I don’t want to diminish any of that. But at the same time, recognize that sometimes the fears can run much further than what is actually happening.

Looking back at history and other public health crises we’ve faced, such as SARS in the early 2000s and then H1N1 in 2009 — compared to these, how worried are you about coronavirus?

This particular coronavirus, we don’t know what direction it’s going to go in. I think it’s the unknown that is so scary. What we do know is that it’s very contagious and it causes much more mortality than the 2009 H1N1. We don’t know exactly what the mortality rates are. The numbers that are published are around 2 percent, sometimes as high as 2.5 percent. But those numbers are probably highly inaccurate because we don’t know what the denominator is. That is, we know fairly well how many people are dying from it, but we don’t know how many people get it.

So I think that as we do more testing, we’re going to find that it’s much more widespread than we thought. And that’s going to mean that the mortality rates are going to drop [relative to numbers infected].

From what you’ve seen so far in the U.S., do you expect a large percentage of the population to eventually get the coronavirus?

We’ve only known about it for a few months, so we don’t know how it’s going to behave. Is it going to have a seasonality like some other coronaviruses do? Or will it not? Everything that I tell you would be a guess.

I’m certain that coronavirus is much more widespread in the United States than we’ve recognized. And there’s nothing to suggest that it’s going to stop in the immediate future. Maybe some miracle will happen and it can’t live when it gets too hot. But chances are that it’s going to continue for at least a while. And then, of course, if it’s a seasonal infection, if it does go away in April, for example, will it come back next November? A lot of questions. Very few answers.

What makes you think that it’s been in the United States for several weeks?

For every case we identify, and now we’ve identified quite a few that haven’t had any risk factors, that tells you that these people got them from someone, someone else, and we know that, on average, about one person is going to infect about three people.

I think we can assume that there’s got to be an awful lot of people out there [in the U.S.] that are walking around with no symptoms but contagious, or with minor symptoms and contagious. And these cases that we’re seeing are really sort of like the canary in the coal mine. They’re just a beacon for the fact that underneath the symptomatic cases are a lot of people who we’re not recognizing. That makes sense.

Gabriel Greschler

Gabriel Greschler was a staff writer at J. from 2019 to 2021.