CORONAVIRUS PROGNOSIS

Written By: Bruce A. Percelay | Photography By: Brian Sager

Dr. Bob Arnot shares his perspective on the coronavirus pandemic.

Long before the coronavirus outbreak, Dr. Bob Arnot had already been on the frontlines of many dangerous epidemics. From the ravages of cholera in Zaire during the Rwandan Genocide, to sleeping sickness in Southern Sudan, to malaria in Mozambique, to the devastation of AIDS in Haiti, Zimbabwe and Thailand, to the terrifying Ebola outbreak in Uganda, Dr. Arnot has firsthand knowledge of the insidious ebb and flow of infectious disease. In many of these epidemics, he had consulted with or interviewed Dr. Anthony Fauci, the longtime director of the National Institute of Allergy and Infectious Disease who has emerged as the country’s most trusted voice in the coronavirus epidemic. Today, Dr. Arnot has been helping scale the manufacturing of much-needed hospital ventilators while also producing an in-depth course on coronavirus and passing on lessons learned from physicians in London, New York and cities bearing the full brunt of the pandemic. N Magazine spoke to Dr. Arnot at the end of March to get his insights on the virus and what it may look like in the future.

N MAGAZINE: Other than the writers of the movie Contagion, who else saw this coming?

DR. ARNOT: Bill Gates saw it and warned the World Economic Forum in 2017 that a huge epidemic would break down all supply chains. I wrote a book about it called Your Survival. The Centers for Disease Control, which is the finest disease surveillance organization in the world, was always on the lookout for it. They warned us, but we didn’t listen. The states and the federal government were expected to plan for it—but didn’t. New York state needed 15,000 ventilators in reserve. The federal government needed 100,000. They failed. I liken it to someone sitting out on Cisco Beach with a tsunami a couple hundred feet offshore, and everyone is playing volleyball, surfing and talking to their friends—and they don’t realize until the last second that the wave is going to wipe them out. The trouble with a pandemic is that it defies the imagination. Planners and governments cannot justify draconian isolation measures and expensive preparations until they see it with their own eyes.

N MAGAZINE: The United States has been largely immune to these kind of pandemics up until now. Why have we not been able to prevent this and was this avoidable?

DR. ARNOT: The great difficulty is that at each stage we’ve had a staggering amount of warning. We knew a virus like this was going to come. The Chinese saw it in Wuhan and did not act anywhere near as quickly enough. Then the South Koreans saw it. Then the Italians, the French and the British. Now we’re seeing it. So we had very good fair warning. The tragedy is that there is “just-in-time planning” and “just-behind planning,” and everything we’re doing now is “just-behind.” Everything was late, late, late. We had the information, the technology, the manpower and the money to have beaten this thing, but now we’re paying the price in hundreds of thousands of dead. The tragedy is how avoidable much of the fallout was. I’ve been working on ventilators. The idea was to have nearly zero inventory of parts. Now that they need to scale production, these parts are scattered all over the world. One key part is in Malaysia under lock and key. They couldn’t be scaled fast enough to meet the demand in New York City. We found the ventilators in the national stockpile were missing parts and had older hoses which didn’t work.

N MAGAZINE: Where were the specific failures?

DR. ARNOT: Failure number one is that local bureaucrats in Wuhan did not alert their own authorities in Beijing. Then the Chinese failed to warn us early enough. The World Health Organization was too conservative in their warning. Even with late warnings, the US didn’t cancel flights from China early enough and didn’t screen and test those who arrived. We thought it was a Chinese problem. The biggest mistake of all was not having tens of millions of tests deployed. When the Chinese were going through their crisis, we should have stockpiled millions of those tests. Why? What stopped the epidemic in China was widespread testing. Everyone who tested positive, who was symptomatic or who was in contact with those people were all isolated. Now they’re down to zero cases. We didn’t warn our own people to isolate weeks before they did. We valued instilling calm over saving lives. To calm people, New Yorkers were told to wash their hands when they should have started distancing, canceled schools, stayed off the subway and buses instead of believing that handwashing would save them. We ridiculed using masks until the beginning of April. Our own CDC lost an entire month with a badly flawed test. Even at the height of death in New York City, there was only enough testing for healthcare providers and patients. Doctors and disease modelers are blind without testing. We flew blind through the major stages of the pandemic in the United States. We could only test those with active infection. There was no approved antibody or PCR blood test to determine the scope of the infection. This would have detected those who never had symptoms and shown us the background number of those infected. [As of the first week of April,] the current test only shows active infection.

N MAGAZINE: Why doesn’t anyone understand this virus and its behavior?

DR. ARNOT: It’s like a young child; you don’t know exactly how it’s going to turn out. It’s a very young virus and we really don’t know all its characteristics so far. We also have several experiences that are vastly different in each country effected. What are the variables? In Italy, for instance, it’s a multigenerational country where kids and grandparents live in the same house or same neighborhood. In New York, you have millennials who are all super social who may also infect their elders. In Germany, young skiers brought the virus back, so the initial death rates were lower. So there are different situations, different healthcare systems, different capacities.

If you look at the data from St. Thomas’s Hospital in London, people who have a high BMI, high metabolic syndrome, or women who are pregnant or have just delivered are on ventilators because their immune response is compromised. Most intriguing, the older individuals on respirators in London all had very old biological ages, meaning that an accumulation of risk factors and illnesses put them at high risk. The hope is that the very fit, lean older person who battles back their risk factors may have a lower risk of serious illness.

N MAGAZINE: Are we learning anything new about how the virus behaves that is important to keep in mind?

DR. ARNOT: The most important watch word of all is that the virus kills quickly once you start to get short of breath. Many die at home not realizing that their blood oxygen levels are plummeting. After four to six symptomatic days with the virus, when they start to get short of breath, they have only eight hours to get on a ventilator. It’s eight hours between when you get short of breath to when you’re either dead or on a respirator. The advice should be that when you start to get short of breath, know which hospitals have ventilators and high flow nasal oxygen devices and head there quickly. The most frightening aspect is the number of asymptomatic individuals who may spread the disease. The disease may also be spread by breathing alone without the need for a cough or sneeze. So, you may be in a bar or restaurant or airplane with a carrier who has no symptoms and doesn’t even cough, yet become infected.

N MAGAZINE: Many believe that the coronavirus is behaving like the Spanish Flu, which came in two waves, the second of which was far more devastating. Do you believe that’s the case, and if so, how do we lessen the impact of that second wave?

DR. ARNOT: There were three different waves of illness during the pandemic. Ironically, the first started in March 1918, much like ours began in March 2020. The pandemic peaked in the fall of 1918 and caused most American deaths. Dr. Fauci now sees a fall and even annual resurgence. There is hope that drugs now in huge clinical trials plus widespread testing and isolation techniques may blunt this wave. The other theory is that we are experiencing these waves right now, as the virus first washed through Washington State, then New York City, New Orleans and then smaller cities.

N MAGAZINE: Do you think this will return on an annual basis like the flu?

DR. ARNOT: Dr. Fauci now says this will likely come back as an annual occurrence, like the flu. With summer coming in the Northern Hemisphere, we hope it will dissipate here but may continue in the Southern Hemisphere during their winter, then return here in the fall.

N MAGAZINE: Beyond social distancing and other precautionary measures, is there a regimen that folks should be doing to help ward off the virus?

DR. ARNOT: China saw the risk of traditional risk factors like high blood pressure, chronic lung disease and diabetes. If you have a risk factor, the biggest thing you can do is reduce that risk factor as much as possible. Now is the time to get as healthy as you can. Call your doctor, and if they’re not slammed, ask them what you can do to address your risk factors. So let’s say you have asthma like me, make sure you’re taking your steroid inhalers to make sure your lungs are as clear as possible.

Second, eat a highly, highly anti-inflammatory diet. One of the easiest things to do is make a smoothie in the morning with cantaloupe, blueberries, kale, spinach and Greek yogurt. That will give you a stunning amount of antioxidants. Get regular exercise. It’s also about distance, distance, distance. If you can get a delivery service to get your groceries, you should. Whoever is going out of your house is the biggest danger to your family, so I’d stay ten to fifteen feet away from people. Be extremely careful.

N MAGAZINE: Are we coming to know any new risk factors?

DR. ARNOT: In talking with doctors in London, Italy and New York, several new risk factors appeared. In New York City, vaping, smoking cigarettes and marijuana put younger patients at highest risk of becoming seriously ill because smoking attacks the air sac or alveolus, the same target as the virus. In London, young people who were overweight were at higher risk of ending up on a ventilator as were some pregnant women. If you are young, you’re not immune to very serious disease if you smoke. For baby boomers, it’s their kids.

N MAGAZINE: From a behavioral standpoint, how do you think this will change life in America?

DR. ARNOT: Life is going to go in a different direction than it was. I think people are going to rethink city life. They’re going to say, ‘This is dangerous. I’m killing myself out here. Spending 80 percent of my day fighting to make a living, going into the subway, going to meetings, not accomplishing as much. Shouldn’t home be in a place like Nantucket where you have an opportunity to enjoy quality of life and still have a job?’

The digital workplace will evolve with stunning speed. Employers who see the tremendous productivity of those working at home will rethink spending money on expenses, offices and flying people to meetings. Older people and those at risk won’t want to travel on planes, trains, buses or ferries to Nantucket. Senior executives will rethink living in New York.

I think it’s going to be a long time until a baby boomer with risk factors gets on an airplane or a cruise ship. But millennials may go back to work and social life as usual, sensing less of a risk. I do think it will also be a tremendously exciting time as digital innovations bring a completely new way of thinking about work and a myriad of new jobs we never imagined.

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