‘We could see daily averages well over 1,000 deaths per day’ going into winter: doctor

Brian Garibaldi, JHU Biocontainment Unit Director, joins The Final Round to discuss his thoughts on the rising numbers of cases across the globe and the most recent developments in the vaccine race.

Video Transcript

MYLES UDLAND: We're joined now by Dr. Brian Garibaldi. He's the director at Johns Hopkins Biocontainment Unit. And Dr. Garibaldi, thanks for joining this show. Let's just start with how you see the pandemic right now as we have five full months of cold weather ahead of us here in the US. And we see cases now hitting record daily highs. How concerned are you about how far the virus has spread, how quickly in these colder months, and what the future might have in store for us?

BRIAN GARIBALDI: Well, we're all very concerned because as we all know, as we head into the indoors and we have colder weather, there's a higher incidence of transmission and a higher risk time period. And we're heading into that dangerous time period with higher rates of infection than we had back in the summer.

And we know this is not just due to increased numbers of tests that are being administered, the percent positive of tests that are coming back with positive results is well over 6% across the country, and in some places as well above 20%. So we know this is not just a function of doing more tests. We know that there's increased viral transmission.

And we also see that in the number of patients who are hospitalized. There are a number of areas in the country right now that are really stretching their ICU capacity. And there's concern that we're going to get back into a situation where we have to start talking about allocating ICU resources, such as beds or medications or even ventilators in some areas.

ANJALEE KHEMLANI: Doctor, Anjalee here. I know that for a long time, we've been talking about how deaths have flowed because, you know, hospitals and health systems have figured out ways to help with the severe patients, whether it's proning, or using some of the experimental treatments like remdesivir and dexamethasone.

But as it stands right now, because of the rise and because of what you've just referenced in terms of needing to allocate beds, I wonder are we going to see, then, a follow-up not just because of the lag time between rising cases and deaths, but will we see sort of record numbers in the same way when it comes to deaths? Or is that what you're preparing for?

BRIAN GARIBALDI: Yeah, I think that's very possible. I think, you know, we're entering a phase where we could see daily average as well over 1,000 deaths per day. In some areas of the country, it could be even higher than that. And even though I think on average, we're doing a little bit better, taking care of these patients, you know, we're looking at times when hospital systems were not as stressed as they were back in the early parts of the pandemic, which contributed to some of that earlier mortality.

So I think as we start to see ICUs filling up and we start to see health systems being extended beyond their capacity, we're going to start to see a rise in the number of deaths, not just because there are more patients getting ill and more people dying, but because we're not going to be able to deliver the kind of care that we would like to if we enter into a crisis mode in the way that we have to provide critical care.

SEANA SMITH: Dr. Garibaldi, just going off that, I mean, it's still so early to tell, and there's so many different estimates out there. But from your perspective, from what we know from your colleagues that you're talking to, when do you expect the pandemic to peak here in the US? I mean, is this something that we should be expecting to see over the next six to eight weeks? Or is it something that maybe we won't see for two, three, four months from this point?

BRIAN GARIBALDI: I think a lot depends on what happens with the holidays. You know, I'm really worried about, you know, what's going to happen after Halloween, if lots of people relax their guard and start trick or treating widely or having large Halloween celebrations. And then we're going right into that Thanksgiving and Christmas holiday period with New Year's.

I think a lot of it still depends not just on whether or not we start having access to vaccines, which is going to take-- you know, even if we do have some good news sometime in the next couple of months, it's going to take six to nine months before we have the ability to distribute a vaccine to a wider group of people.

A lot of it depends on our own behavior. Are we going to continue to socially distance in areas that have been successful in keeping that viral numbers down? And are we going to start doing better jobs wearing masks and socially distancing in the areas where we're seeing more than 100 cases per 100,000 residents?

ANJALEE KHEMLANI: Doctor, I know that one of the things that everyone has their hopes pinned on, obviously, is the vaccine. And we've heard that it isn't going to be all end all. Even if we do get one by early next year, we're still going to have to follow these social distancing rules and all the mitigation efforts.

Where do you see this in terms of how quickly we can get to it? And is that something that health systems, you know, will prepare for, or is it something that is just going to be sort of a wait and see?

BRIAN GARIBALDI: Well, you know, we have to start preparing now for how we're going to deliver and allocate vaccines. And, you know, there's over 40 vaccines that are in the pipeline. Several of them have reached their phase 3 trials. Moderna, for example, has actually completed enrollment. They're just waiting to see if more patients who didn't get the vaccine are going to end up getting sick, compared to those who've got the vaccine.

So I hope we'll have some news sometime in the coming months about whether or not some of the vaccines that are in the pipeline are going to be effective and are going to have safety data behind them.

But I think we have to remember that even with all the pre-doses that have been purchased, having the infrastructure to deliver some of these viruses, particularly some of the mRNA viruses that are-- vaccines, excuse me-- that need to be kept at really low temperatures, developing that infrastructure and then deciding how you're going to allocate according to where the hotspots in the country might be.

We've seen some recommendations about how to tier people in terms of risk groups, starting with frontline providers and then folks who are at higher risk of severe disease or death. That's going to take months for us to be able to have that allocation system in place.

And we also know that depending on how this vaccine or whichever vaccines come to the market, how we advertise and how we approve them, those are actually going to affect whether or not people are going to take them. I was part of a study that just came out in "JAMA Open Network" that looked at different attributes of a vaccine.

And, you know, depending on what country it comes from, depending on what the efficacy rate is, depending on what the side effects are, and depending on, you know, which organizations or politicians endorse that vaccine, that actually has a big impact on whether or not people are going to take it.

And I think one of the things we noted in our study was that if the vaccine is approved under an EUA, as opposed to a formal FDA approval, that's actually going to decrease the number of people who potentially might be willing to take it. So even if we have an effective vaccine, that doesn't mean people are going to take it to get us to that herd immunity level that we need.

MYLES UDLAND: All right, Dr. Brian Garibaldi, the director of John Hopkins' Biocontainment Unit. Doctor, thank you so much for joining the program. Hope to have you back soon.

BRIAN GARIBALDI: Thanks. Always a pleasure. Stay safe, everyone.