COVID19 Interview with Pandemics and Emerging Infectious Diseases Specialist Edward Balkovic, Ph.D. (AKA Dr. Microbe)

Jason Criss Howk, 4 September 2020

As a college adjunct professor of Middle East studies, I get to teach some other professors, and often they have a lot to teach me. I sat down recently with Dr. Ed Balkovic to discuss Covid-19 to help me better understand where things stand and what the future might look like. Ed spent 40+ years in fields of Microbiology & Virology and holds a PhD from the Influenza Research Center, Baylor College of Medicine, Houston, TX.

Is COVID19 (the novel coronavirus) acting like other viruses we are familiar with or is this something new and different?

The first cases of coronavirus disease 2019 likely occurred in Wuhan, China in late 2019. The causative virus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, commonly referred to as COVID19) was capable of human-to-human transmission and spread rapidly around the world. In general, COVID19 is acting like other respiratory viruses (such as flu, common cold viruses, parainfluenza, respiratory syncytial virus).  It is spread through airborne route.  Remember there are other coronaviruses that are truly human coronaviruses and they cause common colds.  I think the COVID19 difference is that it is a new virus that has not circulated through human population before 2019. Therefore, the human population has none or extremely little immunity to it. 

Although COVID19 is very serious illnesses, we are fortunate that this new virus is not producing a high mortality rate as was seen with Spanish Influenza of 1918.  Deaths are primarily occurring in a small group and it is often the elderly and those with other underlying diseases.  Overall, younger adults and children do not appear to be as severely affected.  We will need to do studies, but more recent exposure to human coronaviruses, through common colds in these younger populations, may have produced some cross-reactive immunity.

Is it naturally occurring, or man-made or man-manipulated? This is a very common theory in some circles.

I do not believe it is a genetically altered bioweapon or man-made virus.  I do believe COVID19 jumped from an animal species to humans. 

What is your hunch on its origin?

I believe it is a natural animal virus that jumped to humans (a zoonotic disease).

What concerns me – is the possibility that the virus was being studied in a lab (Wuhan China) and through passage in other animal species or cell cultures became altered to increase its ability to replicate in human cells?  We need to know if this lab virus then accidently infected a lab worker and this individual then spread it out to their contacts? This infected individual could have been asymptomatic or symptomatic after infection creating a big difficulty in tracking the origin.

My biggest issue at the beginning of the Pandemic was the dishonesty of the Chinese Authorities.  I now have a hard time believing a lot of the data coming out of China. We need good data to help find a vaccine and ensure we can prevent future related coronaviruses. 

Is the government at federal, state, and local level doing the right things? What did we miss early on? What should they be doing now?

At the beginning, I think the government agencies did the best that they could using the information they were receiving from the Chinese authorities and initially from World Health Organization.  Mistakenly, based on information from China, U.S. officials believed that COVID19 was closer to influenza disease.  Also, we were thinking it did not transmit extremely well between humans (maybe like SARS and MERS), this was wrong.

Should the governments have required masks sooner?  I do not know, since the experts were saying their use was not needed.  Now masks may be somewhat useful, if very low levels of virus from asymptomatic folks can induce infection.  Masks will control spread of droplets and smaller particles, but COVID19 virus is so small that viral particles should be able to pass through a cloth mask.  I worry that when folks put on mask, they believe that they are protected and reduce performing other more important preventative measures. Duke University just did a solid study on mask rankings to help people choose the best one.

The President made the mistake of suggesting that malaria drug hydroxychloroquine might be useful in the treatment of COVID19.  The media then compounded that mistake by turning his comment around to say that the President says hydroxychloroquine is “a miracle cure.” Government and the press must be careful in their statements and the public cannot be in a rush to follow untested ideas when they first come out.

Did we reopen too soon? It depends. I do not know the right answer.  We could not keep our economy and society closed forever or at least until there are no more COVID19 cases.  Governments made the right recommendations to help reduce transmission upon reopening – 1) stay home if you are sick, 2) wash your hands frequently, 3) sanitize your hands if you cannot wash them, 4) social distance, 5) stay away from any crowds, especially indoor crowds, 5) wear masks.

I think the biggest problem after “reopening” is that too many people, especially younger ones, forgot about continuing to follow the other recommendations – social distancing and avoiding crowds (especially indoor crowds). 

I do not know of anything that the Federal Government Experts recommended that the federal government did not do.

Were the governments (local, state, &federal) fully prepared? No.  But what level of preparation is appropriate and acceptable is the big issue, and it shouldn’t be a political issue, it is some science and some art.  This question of preparedness goes out all political parties, elected officials, and government bureaucrats. How many ventilators should be sitting in warehouses in case they are needed someday. How many or how much PPE should be on-hand? What diagnostic kits, vaccines, anti-viral therapies should be developed for animal viruses that have not yet jump to humans and become highly transmissible? It is difficult to answer and so many medical supplies expire or get outdated by new technologies. 

We should all recall a statement from Mr. Richard Clarke, former White House Director of Counterterrorism, “Democracies don’t prepare well for things that have never happened before.”

We need to be imaginative and realistic, you can’t prepare for everything, but we can have a process for dealing with new massive problems. We need to accept that in disasters and health crisis events: 1) lots of money will be thrown at the problem very quickly and  a percentage of that money will be wasted or miss-used; 2) new laws and regulations will be enacted and hopefully they will not add to our problems; and that 3) after a few years with no new pandemics, preparedness money will be reduced, and supplies will not be reordered, and vaccines / therapeutic agents will expire. 

Is this like the flu, just something we should adjust to from now on and hopefully vaccinate against? Or will do we need to completely isolate and stop it?

I do not believe COVID19 will disappear even if effective vaccines and therapies are produced.  I think it will become another of the respiratory viruses that the world will have to deal with year after year. 

Hopefully, as herd immunity to COVID19 builds up (whether by recovery from infection or vaccination), the virus will slowly become less lethal and become a childhood disease. Historically, viruses do not benefit by remaining lethal.  Viruses only survive when they can pass from one human cell to another.

Should schools reopen with protections for more at-risk faculty? Won’t the kids just deal with it and become immune?

I do think schools should and need to reopen following the guidelines issued by the Centers for Disease Control (CDC).  The local COVID19 disease conditions, both in the community and in the schools, should be considered and reviewed continually.

I believe the hardest part of reopening schools, economy, and society overall is that Americans live with the belief that their lives should have 0% Risk. 

If 0% is unrealistic, and it is; then what is the acceptable level of Risk?  Acceptable level of risk will be different for different populations.  Remember we have seasonal influenza epidemics each winter, where millions will become infected and hospitalized. Also, it is estimated that between 30 – 50,00 people will die.  But we do not close our society and economy each winter.  Yes, COVID19 is a serious, deadly disease; but it is not the Spanish Flu or Black Death.   

What is the best way to report on COVID19 progress/spread?

(Cases identified, deaths, or the death rate per a certain population?)

Are you convinced that all the COVID19 deaths are actually COVID19 or is there some inflation because health facilities get more funding in for COVID19 deaths?

I feel the way the data is being reporting is not giving a full view and understanding of the COVID19 Pandemic.  Right now, the only data we are generally given are # of new “cases” along with cumulative # of cases and # of new deaths along with cumulative # of deaths. 

Here are the additional data numbers we should be given include: symptomatic vs. asymptomatic “cases”, “cases” of mild vs. severe illnesses, current # of patients in hospital and ICU, the age demographics for all of these groups.    

The reason I put “cases” in quotation marks is I have not yet been able to find what defines a case. Is it by symptoms, only a positive antigen (PCR) test, does it include positive in antibody tests (previous infection)? The same with COVID19 deaths. Does COVID19 have to be a direct cause of death or just present at time of death.  Remember we have been told underlying conditions, such as heart disease, diabetes, obesity, etc., play a big role in patients with serious disease.

Regarding # of COVID19 deaths – I worry that # of COVID19 may be getting somewhat inflated because of they are occurring during this high publicized pandemic. But many deaths, such as those occurring at home, may not be getting reported. I do not think we will ever get a truly accurate counts on # of deaths.

What has troubled you the most about the world response to COVID19?

I believe the most serious problems we have encountered is that this COVID19 pandemic has been politicized since the very beginning.  The Trump Administration tried to put on the most positive spin it could, while the Democrats with the support of the media saw it as a great opportunity to destroy the President and prevent his re-election. Being a Presidential and Congressional election year, all this politicization has only been heightened to the extreme and it made the pandemic worse.  

Additionally, at least at the beginning, I do not think the “Experts” realized the media were asking questions in a way to get them to answer in ways to drive a wedge between them and the President.  I think the media were doing the same to the President and he kept taking the bait.  

Can we expect a vaccine soon and what will be the impact?

I hope we will see a safe and effective COVID19 vaccine in the very near future. However, I am not willing to bet the house on it.  From working in the vaccine industry – I want to note that historically it has taken at least 5 – 10 years to get a new vaccine from R&D, through Clinical Testing, and finally Licensure and Manufacture.  I know the industry is working at “Warp Speed.”  However, many (if not most) of these COVID19 vaccines are being developed by companies who have never developed and produced a licensure-able vaccine.  In addition, most of the technology platforms being used have never produced vaccines. There is always a concern about unacceptable reactions to new vaccines when they are given to millions or even billions.

Do not forget that COVID19 appears to be the deadliest in elderly populations with underlying diseases.  These patients, historically, do not respond well to other vaccines.  How will they respond to COVID19 vaccine made on a biotechnology platform?  No one knows? So, does that mean we will need to vaccinate younger populations, who as of now are less susceptible to serious disease, so that we can build herd immunity?  Will they accept vaccination?  Will it have to be government mandated?

Will the vaccine (s) solve all our problems?

I believe there are about 100 COVID19 vaccines currently in development. How can we know that the first vaccine to be submitted for licensure will be the best vaccine?  Since COVID19 is a new virus just recently introduced in the world’s human population, we do not really know what type of immune responses are generated after infection and hopefully will be capable of preventing reinfection.  Therefore, how do we assess the responses seen after vaccination?   What is the most desirable vaccine response? We do not know. What happens if multiple vaccines are licensed, each producing a different pattern of immune responses? How will physicians know which vaccine is best for their individual patients? Here is where the art has to overtake the science a bit, we will have to make some best guesses and experiment. There will be mistakes and the politicizing of the issue won’t help.

I believe most Americans want 100% safety and effectiveness with 0% Risk with their vaccines.  I do not believe we have ever developed a vaccine that meets these criteria.

I hope the “Experts” can address all these vaccine concerns.

What do we do while we wait for a vaccine?

I think our best immediate hope to “control” this COVID19 Pandemic and reopen society will be the approval of safe and effective therapies that can prevent serious disease progression and death.  Other viral diseases have been successfully treated with specific antibody plasma therapy.  Hopefully, it will work for COVID19.  Also, I hope we can repurpose current anti-viral drugs and develop new ones that will effectively treat COVID19 disease.

Remember we have controlled HIV disease using anti-viral therapies and after ~35 years we have still not developed an effective vaccine against HIV.  Not to mention, several other human viral diseases that we have also still not been able to develop effective vaccines – herpesvirus, cytomegalovirus, respiratory syncytial virus, and human coronaviruses.    

Are there more COVID19-level health issues coming?

As the world’s human population continues to grow and continues to alter the environment; new contacts with wild animal species and their diseases will also continue to increase.  Therefore, we better become used to, and hopefully prepare better for, these future contacts.

I think we are still waiting for “THE BIG ONE.”  The question is not if, but when.

Dr. Balkovic is an Adjunct Associate Professor – Department of Cell & Molecular Biology, University of Rhode Island (URI) and has taught graduate courses on Pandemics, Emerging Infectious Diseases, & Bioterrorism at URI since 2001. His Thesis was titled the Evaluation of Antibody Responses to Influenza Virus Antigens in Murine Model.  He supervised National Virology Reference Lab serving all U.S. Dept. of Veterans Affairs Medical Centers, has 20+ years Subject Matter Expert (SME) Microbiologist – Sanofi Genzyme, and spent 30+ years working on Vaccines, Biologics, & Biopharmaceutical industries. Ed directed Viral Vaccine Quality Control Testing and later Senior Research Virologist at a major vaccine manufacturer – Connaught Labs (now Sanofi Pasteur); and is a member of Science Advisory Board at Parenteral Drug Association (PDA)