In this Fireside Chat, we spoke with Dr. Julie L. Gerberding, Executive Vice President and Chief Patient Officer at Merck Co., Inc. We discussed COVID-19 and the balance between the necessity of social distancing and essential health care and civic services.

Dr. Gerberding is uniquely equipped to speak about the coronavirus (COVID-19) pandemic. She’s the former director of the Centers for Disease Control (CDC), where she led for seven years. She is also an internist specializing in infectious disorders and clinical pharmacology.

H1N1 vs. COVID-19: Similarities and Differences

We can learn much from the pandemics of the past. For example, the 2009 H1N1 pandemic was a “disease that globalized very quickly,” according to Dr. Gerberding. H1N1 strained our healthcare system, but in that case, many patients who were hospitalized or who died were relatively young. This could be due to prior immunity in the elderly population.

“It came fast,” Dr. Gerberding says, “and it really did create a significant surge across our entire healthcare system.”

The difference, she says, was in our preparedness level.

“We were at our peak preparedness for influenza going into the actual pandemic,” she says.

Healthcare systems nationwide had been preparing for a possible pandemic for several years beforehand. Providers and decision-makers felt relatively well-equipped to handle any safety measures that needed to be implemented. The main ingredient the H1N1 situation was missing was uncertainty.

“That epidemic was a bit different than what we’re facing right now,” Dr. Gerberding says. “There was much less uncertainty.

“We understood how influenza is transmitted, and we understood basically how to care for the patients who had it. And we had a sense of confidence that we would eventually have a successful vaccine, plus the medical treatments that were already available in terms of antivirals.”

Prior to COVID-19, however, Dr. Gerberding feels that we relaxed into complacency. The U.S. saw very little direct effect from Zika and Ebola. Neither virus ended up posing the sweepingly broad reach of influenza or coronavirus.

As a response to the virulence of COVID-19, the U.S. is practicing social distancing in hopes of slowing the spread. One major benefit of slowing the spread is to keep society running as smoothly and effectively as possible.

“As we slow down spread, we must keep our healthcare system functional. We need our police, we need our fire workers. For Merck, we need to make sure that our medicines – particularly antibiotics and our other infectious disease therapies – are still being produced.

“We must protect our health workers. We must protect our front-line civil servants who are keeping us safe and secure in our home environments. And that balance is what decision-makers are really struggling with right now,” she says.

“Everyone keeps saying we can flatten the curve. The main reason for this is to protect our healthcare system. And I think that’s really the critical priority.”

When Will Social Distancing End?

When it comes to social distancing timelines, Dr. Gerberding says it’s too early to predict what might happen. We look to China and see that they appear to be on a downward slope in their curve. However, they also haven’t returned to everyday life yet.

“As we watch what happens when the Chinese people begin to trickle back into their daily lives, it won’t be surprising if we see a resurgence of transmission,” she says. “I hope that doesn’t happen. But I’m not going to be surprised if we see it. And that will teach us a lot about what’s the long-term opportunity here.”

In the U.S., we still aren’t testing broadly for COVID-19. As Dr. Gerberding expected, we began seeing a sharp spike in cases with the increase in available tests. While the spike doesn’t necessarily indicate speed of transmission, it gives us a clearer picture of how many people actually have the virus.

“[The spike] will scare everybody,” she says, “Right now, I suspect that we’re only picking up the tip of the iceberg of the sickest people.

“A great number of people with very mild or virtually asymptomatic infection comprise the base of that iceberg. And we just don’t know how big it is.”

An uptick in cases – and increase in patient observation – means we’ll get a better picture of the virus and how it runs its course. Dr. Gerberding hopes we will be able to soon identify a prophylactic antiviral to administer to exposed individuals, rather than having to wait until they require hospitalization.

“At that point, their lung tissue is already so damaged that it’s very difficult to save them,” she says.

Test accuracy is paramount, Dr. Gerberding says, especially because the clinical and public health decisions made going forward depend on getting the right results.

In terms of a possible COVID-19 vaccine, Dr. Gerberding says she doesn’t expect one to become available just yet. She cites the long process of developing and approving an Ebola vaccine as an example. Merck Co., Inc. began developing the Ebola vaccine in 2014, but it wasn’t approved by the FDA until 2019.

“We are very humble about the timelines for vaccine development. Even with these wonderful new platforms and clever approaches, I just can’t imagine we should be expecting any kind of public vaccination program for at least a year,” she says.

COVID-19 and the Foreseeable Future

People across the country are nervous about the foreseeable future – particularly how long social distancing will need to be required. Although the current recommendation is a two-week period, Dr. Gerberding says the two weeks really just gives the government and society a chance to pause and come up with a game plan for what life will look like as we continue to practice social distancing for a longer period of time.

Businesses will need to continue operating. Managers will have to figure out how to distance and stagger team members on their shifts. Two weeks of caution won’t end the transmission, so we’ll all have to adapt in the meantime.

“We all expect that we’re going to see this thing get worse before it gets better,” Dr. Gerberding says.

Rather than pretending we’ll all be back to normal in two weeks, she says we should instead view the two-week period as a pause. During that time, businesses will need to determine how best to protect their workers and customers.

“We need to help people understand that this two-week period is kind of a pause to regroup – maybe reset the time frame,” she says. “And then, we develop some practical measures for how we rebalance what we need to do to reduce the transmission – while, at the same time, keeping our essential services and communities running.”

To listen to the full conversation, click here.