Interview of the Week: Dr. Celine Gounder, Coronavirus Expert

Dr. Gounder is a Clinical Assistant Professor of Medicine and Infectious Diseases at New York University.  She is also the co-host of  Epidemic, a podcast about the COVID-19 epidemic with former Ebola czar and #FOP Ron Klain.

ODP:  We know with your terrific podcast Epidemic, you are working to broadcast reliable and useful information about the virus.  What is the biggest thing the mainstream media is getting wrong?

CG:  The mainstream media focuses on viewer/listener questions. This isn’t wrong. But the problem with this approach is that if you don’t introduce some new information, they won’t even know what else to be thinking about and to be asking.

ODP:  How important is it to reduce air pollution generally in order to minimize the impacts of other coronavirus type infections in the future?

CG:  If we want to reduce the risk of infectious disease epidemics and pandemics, we need to address air pollution. We need to address deforestation and the loss of other wildlife habitats. And most importantly, we need to address climate change. It’s sad that it’s taken a pandemic of this scale to make us realize this. But I think when we come out on the other side, we’ll take this a lot more seriously.

ODP:  Many in the environmental community have warned about the dangers of wildlife markets like the one in Wuhan.  Understanding cultural differences, can regulating those help stop diseases like this one from being transmitted from animals to humans in the first place?

CG:  I think in general, the more we can control our exposure to wild animals and wild habitats, the more we can reduce our risk of zoonoses (i.e. infections that cross over from animals to humans). This isn’t just about the food we eat. It’s also about climate change and the environment.

ODP:  How are the effects of the virus worse for people who smoke or vape and for those who are exposed to indoor air pollution from smoking?  

CG:  There is no question that smoking, vaping, and indoor air pollution increase the risk of severe disease from SARS-CoV-2 coronavirus and really any respiratory viral or bacterial infection. A friend of mine who runs a neuroscience lab at Duke reached out to me this morning. He’s had to shut down his lab due to social distancing measures. But he said that he needed to use his “science brain for other things,” and he asked me about the link between vaping and COVID19. I asked him to look into this for us. How do rates of vaping in Europe compare with those in the U.S.? And what might that say about rates of severe COVID19 disease among young people in the U.S. versus Europe? What do we know about the impact of vaping on the lungs and our immune systems? And what might that predict regarding severity of COVID19 disease.

ODP:  Some experts think the warmer weather may make this virus “go away.” Do you agree? Will the warmer weather associated with climate change actually make the spread of infectious diseases worse in the future?

CG:  The warmer weather will NOT make the virus go away.  Here’s the pattern we see with other respiratory viruses, including other coronaviruses. They subside in the warmer, more humid months, at a time when we also spend more time outside, in less crowded conditions. Then in the fall and winter, they come back. It’s colder and drier. We’re inside more and around each other more. It’s cough and cold and flu season. Here’s one paper I’d refer your readers to: https://doi.org/10.1101/2020.02.12.20022467.

ODP:  Many of us live in big cities. You treat patients in Native American communities.  How problematic is this disease for people who live in rural, isolated places with limited medical facilities?  How high is their risk?  Is it lower than people who live in closer proximity?

CG: Sadly, there’s a long history of indigenous peoples dying from infectious diseases imported by Western settlers into their communities (in some cases intentionally): measles, smallpox, tuberculosis, and influenza. Today, over 70% of indigenous peoples live in urban areas, but many do still live in rural areas on reservations. Some of these reservations are more isolated from outsiders than others. The more rural these communities and the more they’ve been able to hang on to their language and culture, the healthier they tend to be. But with a disease as infectious as the SARS-CoV-2 coronavirus, it’s only a matter of time before these communities are affected. 

The Indian Health Service has excellent leadership when it comes to infectious diseases (Dr. Jon Iralu is a dear friend of mine), but the IHS is also hampered by underfunding. The IHS spends about half per capita what Medicaid does (https://www.gao.gov/products/GAO-19-74R).  In addition, many diseases common among indigenous peoples — such as cardiovascular disease, diabetes, liver and kidney disease, and autoimmune disease — will put them at increased risk for severe disease and death if they are infected with SARS-CoV-2.

Thank you so much, Dr. Gounder, for sharing your wisdom with our readers during this busy time.  And for more, we recommend Epidemicthe latest episode is available today.

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