An interview with a hand-washing expert about coronavirus

Doctor and ‘Atlantic’ staff writer James Hamblin, the author of the one good story on COVID-19, unpacks what we should be worried about.

An interview with a hand-washing expert about coronavirus

Doctor and ‘Atlantic’ staff writer James Hamblin, the author of the one good story on COVID-19, unpacks what we should be worried about.

One of the most frustrating things about the coronavirus is all of the bullshit and anxious bleating that passes for informed commentary. Fortunately, there are some intelligent people who understand the scope of the crisis, and what is useful everyday information to have about it.

James Hamblin, staff writer at The Atlantic and an actual M.D., is one of those people. A recent piece of his, published on February 24 and titled “You’re likely to get the coronavirus,” is the most enlightening thing I’ve encountered on the crisis so far. He lays out, in simple and direct terms, that what makes the coronavirus so hard to contain is that it’s relatively banal with flu-like symptoms (and the capacity to turn into fatal pneumonia). But what remains a tremendous danger is that our healthcare and pharmaceutical systems are poorly prepared for the reality of a surge in sick patients.

Another, further helpful piece he recently published explains some practical measures that you can take (including the right ways to wash your hands). I spoke with Hamblin on Thursday afternoon about the outbreak and the measures being taken to deal with it; this conversation has been edited for clarity and length.

How is the coronavirus outbreak making people sick?

It's in some ways like a very severe flu. But the disease also manifests in very different ways, and that's part of why it's dangerous. It's different from say measles or Lyme disease where you have this characteristic rash, and where you could diagnose it almost without a test. People aren't bleeding from their eyes, and there’s nothing that makes you say “Oh, that’s clearly a case of COVID-19,” as it looks a lot like cold and flu. But it's more likely after a long period to get worse and worse, and develop into pneumonia that can be fatal.

That's what's dangerous about it, and that’s what has the potential to cause panic. Normally, people get colds and we are used to people who are in good or fair health used to getting a cold. It’s an annoyance and it may be uncomfortable for awhile, but there’s not a sense that you won't get through this. And it doesn't take a ton of cases to make people get really scared [that they have coronavirus], so then people will go to hospitals and to see doctors, potentially flooding the health care system.

A friend yesterday sent me a photo from the New York subway of a man wearing one of those masks like a graffiti spray painter wears. My assumption is that that sort of thing is excessive and unwarranted — would that be fair to say?

The advice right now about masks [that people shouldn’t be rushing to buy them] is drawn from the fact that we don’t have enough, and we need to preserve them for our health care workers.

Subways are an interesting question — you need to be very close to actually get this disease from directly inhaling a person's respiratory droplets, as I understand it right now it’s about six feet, which means you’re probably going to get it from someone you spend time in a close interaction with who is sick. And on the subway someone would have to cough or sneeze in your face — it’s not airborne like they’re going to be able to infect someone at the other end of a subway car. And that would be a case where masks would be needed, but the masks are most clearly needed by healthcare workers who are going to need to get in the face of someone who's coughing and put a tube down their throat. We’ve made an emergency buy from 3M for millions of more masks, and we have a small emergency stockpile.

It seems like there’s a lot of anxiety about whether people should be going to restaurants, riding the bus, and so on. And while retreating a bit like this is not quite as extreme as quarantine or social distancing, is it something that makes sense for people to do?

Thinking of say, Brooklyn, and all the different shops and bodegas that operate on thin margins, if they have a slight drop in their business that would be devastating. If there’s an order for people to stay in their homes for two weeks — not a panic order like in China with drones chasing people around — but even a general health warning that people should try to work from home if they can, it would have a significant impact on a lot of hourly wage earners who wouldn’t be able to make rent.

Any recommendation like that is not without consequences. And if everyone stayed at home and never left, while that seems to have worked in China, it… would have all these other consequences here. There might come a point where we get that directive, and that would come if our healthcare system is kind of overwhelmed and we’re to the point of not being able to care for people who we should be able to care for. That’s the worst case scenario.

Aside from the overwhelming demand for stuff like masks and Clorox or whatever, are there signs that the healthcare system is going to be overwhelmed?

Yeah there are people who, and this is the next story I’m working on, have modeled scenarios like this for similar diseases with similar characteristics. And we have stockpiled supplies, including ventilators [used to treat people in respiratory failure], and some people believe these stockpiles have to be mobilized. These supplies are around for bioterrorism purposes, but they may need to be used in this case, because of the way our healthcare system works.

Hospitals like to operate at around 90 percent capacity, as an open bed costs a lot of money to a hospital, especially in the ICU. You wanna be pretty much sold out, so when there's a surge they can send extra patients to other adjacent hospitals… and this case might present new and different challenges. because you don't necessarily want to bring infectious patients to another hospital and they might be full too. Certainly some hospitals will face these challenges, but we don’t yet know how widespread or severe they'll be.

Another broad concern is the gulf in perception of the outbreak between cable news and newspapers, and the Trump administration’s active disavowal of the outbreak as a real crisis. To what extent are experts or monitors worried about the effect that this gulf in reality can have?

It’s an interesting moment for that kind of stuff. When things like climate change are denied, the effects are not immediate and you could choose to find ways to deny them. But as more tests are made available and there are more confirmed cases, presumably, and more people are affected in real life, it will be harder for people not to see that tension. If you know someone who's gotten this, especially if they've gotten really ill or died, it'll be hard to believe hearing Trump say it's not that big of a deal.

If people are to prioritize what sorts of changes to their lifestyle that should make to be as responsible as possible, what’s most important? I think the humor in saying stuff like “don’t touch your face” kind of masks some confusion about what stuff can have a real impact.

It’s a lot of the stuff that we were just never really good at before that we need to actually do now. For instance, making sure employees feel able to call in sick. And expanding paid sick leave to where people don’t have it now. Hourly wage employers will need a way to encourage people to stay home, because really we’re just going to slow this down. The way you avoid those surges [in the healthcare system] is to slow the spread of the disease.

It may be inevitable that we can only slow it, and that means hand-washing, social distancing, and staying home when you are sick and self quarantining. Normally we should all be doing that! 500,000 people die globally of the flu every year, yet a lot of us are out here with coughs and sneezes and going out to restaurants and work and we should be better about that and we’re not. And at this moment we could actually try to adhere to that.

And if someone does go out to a restaurant or to work, who are the people put at risk by that decision?

With this and with the flu, it’s older people and those with chronic diseases and impaired function. That’s the problem it’s the hubris of healthy young people who think the limiting factor in whether I go out is whether I feel up to out and not whether I’m a risk to other people. You might feel up to it but you're coughing, and then you cover it with your hand, and then you pass on the infection.

As a last question, have you seen the Steven Soderbergh movie Contagion? Given its recent spike in popularity, I wanted to ask if you had any opinion on it.

No, I haven’t seen it. Given that I’ve been kind of living and breathing this virus story for quite awhile, when I watch something I want to escape from that for a moment.

Noah Kulwin is the Future Editor of The Outline.