Dr. Dan Hartman: COVID-19: What Does the Future Look Like?

Dr. Dan Hartman is the director of Integrated Development for Global Health at the Bill & Melinda Gates Foundation here in Seattle, and in this episode of the Rise Seattle podcast, Dan helps us to better understand the ever-evolving situation surrounding COVID-19. 

Dan and podcast host Tyler Davis Jones chat via Zoom, and Dan answers questions like:

• What is the U.S. healthcare system experiencing now? 
• Is Washington State on the tail end of this? 
• When and how do you think we'll get back to normal? 
• What is the Gates Foundation doing in response to coronavirus? 
• Where did we go wrong in our response to this? 
• If you could wave a magic wand and make everyone know and understand one thing, what would it be? 

As a physician trained in internal medicine and pulmonary critical care, Dan now works with a highly talented team in product development assisting the different disease area teams at the foundation.

Dan starts off the episode explaining some of the science behind SARS-CoV-2, the virus that causes coronavirus disease 2019 (aka COVID-19):

“It’s very different than the flu… the way it's transmitted is about 2 - 3 times easier than the flu, AND it’s about 10 - 20 times more deadly,” he shares. “When you combine those 2 things together, that’s when you start seeing healthcare systems start to be crushed under the weight of this particular disease.” 

As far as what the U.S. healthcare system is experiencing right now, Dan has heard from friends who still work in hospitals who are experiencing firsthand everything that’s been happening. In the past couple of weeks, COVID-19 has been hitting different parts of the country in waves, and in some places, the majority of patients that are coming into a hospital have COVID-19. Some first responders are also reporting that 90 - 100% of people they’re helping are all dealing with COVID-19. 

While those who need intervention from the healthcare system are in the minority of cases, it’s still enough that in many places, it’s completely overwhelming the healthcare system. Many people can stay at home and get better, but the people who are seeking healthcare are the ones who are experiencing serious respiratory symptoms such as shortness of breath. 

And of course, there are many people who are pre-symptomatic and asymptomatic but aren’t aware of it. 

“What we’re learning is there are a significant number of people who are walking around without symptoms, and that’s both good and bad,” shares Dan. “It’s good that they're not having symptoms, it’s bad that they’re walking around spreading it.” 

COVID-19 has a much longer incubation time than the flu, making the spread even more likely. 

“I think it was a really good idea to start to request that people would wear masks if they’re going outside and are going to be close to people,” Dan says. 

TREATMENT FOR COVID-19

“It’s important for people to understand that there’s no specific therapy to treat SARS-CoV-2 and it’s really just supportive care,” Dan says. There's a lot of misinformation out there right now, and there have been many reports that specific treatments are helping people get better. But anecdotal success stories are much different than actual studies. 

“If you’re on a ventilator in an ICU your probability of getting off is only around 20%. And almost all of those people are getting these drugs,” Dan shares. The drugs that Dan is referring to cover a wide range of potential treatments; if a patient is in serious decline, doctors are using all of the knowledge and tools that they currently have to try their best to treat their patients. Sometimes their methods work, and sometimes they don’t. 

Of course, this is not a long-term strategy, and the Gates Foundation is actively working on treatment options. 

“We’re working on 10 to 15 different products that could work in this area,” shares Dan. 

“It’s great working with two humanitarians like Bill and Melinda, and they jumped into this just like we jumped into Ebola,” says Dan. “For the pandemic we’re currently in the middle of—or even at the beginning of—the response was quick, and we’ve set up all kinds of different things. We have like 20 different workstreams going on looking at a whole host of different signs whether it's therapeutics, diagnostic, vaccines, the [treatments] you’ve mentioned.”

The Gates Foundation is especially focused on how they can help low-income countries deal with this in the near future. Dan paints a picture of what COVID-19 will look like in different low-income countries with fewer resources, and for many, the situation will be much more dire.

 

WHAT HAPPENS NEXT? 

“I think Seattle has done a really good job in terms of trying to control this. We were the first city to really have to deal with this,” shares Dan. 

But while Washington State may be “flattening the curve,” Dan adds that “the delta between where we’re at today and where we need to be is still far.” 

Tyler asks what our new norm is. How do we come out of this, and what’s the trajectory? Tyler also wonders if wearing a mask to the grocery store for the rest of our lives is the new normal, or if we just need to do this for the next few months. 

Dan thinks the answer is somewhere in the middle. “This does not have an off switch,” he says. “There’s a whole bunch of different things that need to happen before we come out of what I might call Phase 1 and into Phase 2. So we’re going to have to see the number of cases continue to drop dramatically so we know that there’s not ongoing transmission. We’re going to have to have testing widely available.”

That brings up a few big questions: When will we have enough tests? And where did we fail in this situation when it comes to testing? 

“I think we failed in just about every way imaginable,” Dan says.

Not only did we not have a great test, but the test we did have wasn’t widely available. Even when a test was available, it became about whether or not you could get the results back in a timely way so you could actually act on the results. Then, even if there are enough tests, they might run out of nasal swabs, for example. 

“I think with the information that I have today, life will be different until we get a vaccine, and that’s 12 to 24 months away. How different it will be I think remains to be seen… It will be different, I’m predicting for months, if not years, and restrictions that we’re going to have could change over that time period too.” 

“There really isn’t going to be an off switch to this,” Dan adds. “There’s going to be an off ramp. So what we can all do is pay attention to good information and try to adhere to the guidelines. Where am I hearing the best information? Probably people like Dr. Fauci from the NIH… he’s really been spot on with all of his advice.” 

At this point, Dan says that experts aren’t positive yet as to whether or not those who have had COVID-19 are immune to getting the virus again. There are some reports that people have had it twice already, but the evidence is not concrete enough to know for sure. Either way, “Everybody should have some type of test of immunity at some point,” he says. 

Once many people can return to their normal everyday lives, there are healthcare experts who are saying that people over 60 should probably continue to shelter in place as best they can. “I joke with my parents who are 84, the next time I see you, I’ll be bringing a vaccine,” adds Dan. 

With the economy taking the hit that it has, it also has people wondering if the cure is worse than the disease. “I think the disease is probably worse than the cure, but at a certain point, that will flip, and people just have to get out and the economy has to get going again,” Dan shares. “But we have to do it in a smart way and this is where we use the best science that we have today to make those decisions.”

“I’m quite hopeful that we’ll get out of it, I just don’t know what that will look like. And I'm energized to try to be part of a group that’s working on ways to get us out of it. This is something like none of us has ever seen in our lives.” 

Dan leaves us with some other great advice that we can all use as we take on the challenging days ahead: 

“Be smart, be kind, and be safe.” 

Here are a few links that you may find useful: 

Dr. Dan Hartman at the Gates Foundation | Bill & Melinda Gates Foundation Website | Coronavirus COVID-19 Global Cases Tracker by Johns Hopkins University