Harry Gallis, MD, an infectious disease specialist and consulting professor in the Department of Medicine at Duke University, reflects on the history and changing environment and attitudes about infectious disease and what makes our current situation unique.
Infectious diseases have been with us throughout human history – scientists have isolated various viruses in human tissue dating back hundreds, even thousands, of years. While our understanding of infectious diseases and how they spread has grown significantly, much remains unknown, as the current pandemic illustrates. Dr. Gallis has witnessed amazing scientific advances in his field, but also sees our enduring human limitations.
As an intern at Duke University in 1968, Dr. Gallis doesn’t recall any special training or attention paid to the flu, although that was the year of the Hong Kong influenza pandemic that killed millions of people worldwide. Several years later in 1971-72 as he moved on to his residency at Duke, he remembers seeing some otherwise healthy people coming into the emergency room with hypoxia. Several even died including a pregnant woman, which prompted some clinical changes.
“They decided that everybody coming into the emergency room who looked more than mildly ill had to get an arterial blood gas, and if their oxygen saturation was below a certain level, I think it was probably close to 90, they would be admitted for observation,” Dr. Gallis recalled. “But if you go back and look at that influenza season, nobody says anything about it. It just seemed to be a phenomenon related to our clinical practice at the time.”
A Cautionary Tale for Fast-Tracking a Vaccine
Five years later Duke’s Infectious Disease division was gaining traction, just in time for the swine flu epidemic. Public health officials at the time were fearful of a pandemic and they responded by fast- tracking a vaccine.
“They set goals to immunize over 200 million people against swine flu within six months,” Dr. Gallis said. “One of my classmates from medical school happened to be the special assistant to the Secretary of Health at the time, and he was the person who was put in charge of overseeing this program. When it went south, he was the one who caught the blame.”
[Del Meriweather, MD, MPH, US track and field champion and the first African-American student admitted to Duke University School of Medicine, was appointed Director of the US Public Health Service’s National Influenza Immunization Program (NIIP) in 1976. This program ultimately faced much opposition from doctors, pharmaceutical and insurance companies.]
While a direct link between this swine flu vaccine and the higher than usual incidence of Guillain-Barre syndrome among those vaccinated has never been definitively made, the public outcry prompted the government to call off the immunization program. Just over 22 percent of the population, had been immunized by the time the NIIP was stopped in December 1976.
“This has always been cited as one of the hazards of attempting to fast-track a vaccine,” Dr. Gallis said, noting the last coronavirus epidemics – SARS and MERS — dissipated before there was even a thought of a vaccine. “The peculiar thing about this coronavirus [COVID-19] pandemic is that it is not going away, and the reasons are not entirely clear. Whether that has to do with the fact that it’s much more contagious or more easily transmitted or that it persists in the air or on table tops or on peoples’ hands more than other coronaviruses have, we just don’t know.”
Yet Dr. Gallis points out the incredible progress made in less than 50 years in this field. To illustrate this he recalls the mysterious outbreak of a pneumonia-like illness at a Legionnaires’ Convention in Philadelphia in 1976. It took 18 months to grow, isolate and identify this new bacterium, Legionella pneumophila, the cause of what’s now commonly called Legionnaires’ disease. To identify the virus causing HIV took two years. COVID-19 was genetically sequenced in a month.
“So that puts in perspective where we are in terms of the rapidity with which we diagnose and understand things in many ways. But in other ways, we don’t right now know why this particular virus [COVID-19] appears to be more virulent and seems to have a higher mortality. We don’t know the denominator. We don’t know how many people out there are infected, compared to the number of people who get seriously ill compared to the number of people who die. So, to calculate true mortality statistics, we just don’t know enough yet,” Dr. Gallis said.
Anecdotally, though, he knows mortality from COVID-19 is higher than the previous coronavirus outbreaks.
“When is the last time you saw somebody putting up temporary morgues outside of a hospital?” he asked. “That hasn’t happened since 1918 that I’m aware of. Unless it was a catastrophic event like 911 or a plane crash.”
Beyond the Science
Beyond the scientific complexities making this pandemic unique, Dr. Gallis points to technology and politics as complicating factors. Social media has had positive impacts in getting necessary information out quickly, but along with the good information has come a wealth of misinformation, some of it harmful.
He also sees his former colleague at the National Institute of Allergy and Infectious Diseases, Anthony Fauci, MD, having to be more cognizant of politics as he seeks to manage the country’s response to the COVID-19 pandemic and keep science at the forefront.
“I think this is the first epidemic of this type that every turn and twist has been broadcast 24-7 by the media and has had the positive and negative interference of politics in it,” Dr. Gallis said. “When the decision was made to withhold United States funding from the World Health Organization, the Infectious Disease Society of America issued a statement that said, this is a bad mistake. This is going to harm the eradication of polio; it is going to harm the control of measles; it’s going to harm all kinds of things that are going on in the world.
“Scientists are not respected anymore because of this stuff going on in the background, in the media, on the Internet where people are looking at information and believing whatever they see.”
Dr. Gallis feels Dr. Fauci should be the one delivering the media messages as the most respected infectious disease expert in the country today. His job is to oversee the appropriation and administration of infectious disease research dollars and that new information is appropriately based on the science, according to Dr. Gallis.
“Somehow or another, through information and knowledge, the facts have to begin to matter and prevail in this country again,” he said.
While Dr. Gallis admits this is the scariest time we’ve seen in a long time, he hopes that voters and elected officials will remember that we de-fund scientific research and institutions at our own peril.
“You know we’re going to repeat this mistake again because that’s what we do and that’s a tragedy,” he said, pointing to the decades of coronavirus research by epidemiologist Ralph Baric, PhD at the University of North Carolina at Chapel Hill. People will ask, “Why are we giving that guy money?”
“This is why we’re giving that guy money: because all of this matters, and it’s going to continue to matter as human populations take over more previously unoccupied environments on this planet.”
If history does repeat itself in this case, it is likely that we will emerge from this pandemic with new knowledge, but hopefully with a longer lasting memory and the will to not repeat previous mistakes.