During a question and answer session with David Axelrod and several students over Zoom, Dr. Emily Landon said that the University of Chicago Medical Center (UCMC) is now treating approximately 100 patients with COVID-19 and that the hospital is preparing for a continuing rise of coronavirus cases.
Landon, UChicago’s chief infectious disease epidemiologist, became nationally known in March for a speech she gave at a press conference with Illinois Governor J. B. Pritzker announcing the state’s stay-at-home order. In the speech, she exhorted people to practice social distancing for the public good, and said that “without taking drastic measures, the healthy and optimistic among us will doom the vulnerable.”
According to Landon, UCMC is experiencing many of the same supply shortages as other hospitals across the country, as medical supply chains are disrupted by the pandemic and demand spikes for personal protective equipment (PPE) such as face masks.
“It’s like nothing I’ve ever seen before,” Landon said. “We’re living shipment to shipment. We’ve had enough masks and PPE to get us through each day. We like to keep five days of supply on hand.… We’re not sure we’re going to be okay later.”
Landon estimated that the United States lost roughly two months of time to prepare for the coronavirus because of a delayed federal response, a factor that epidemiologists hadn’t previously predicted when planning for a pandemic.
“In every one of those [planning scenarios] there’s a centralized, governmental organized facility for distributing supplies, distributing resources; and a couple weeks in the Defense Production Act kicks in and everybody starts getting their stuff, and we’re just not seeing that,” Landon said. “I don’t understand why the cries from the frontline…are not being heard in a way that has resulted in mobilizing America like America can be mobilized.”
UCMC has been preparing for the coronavirus since mid-January, according to Landon, and has been implementing social distancing measures by separating hospital workstations and holding rounds meetings to discuss patient care over Zoom in order to limit contact between healthcare workers.
Landon has been working with colleagues to develop models that balance social distancing to reduce disease transmission with the selective opening of some businesses to limit economic damage.
She cautioned against relying on the approach of summer to stymie the outbreak, as the change in seasons likely won’t affect the coronavirus the way it does the flu. Landon said that people should be prepared to live with social distancing in some form through the end of summer, and possibly into fall.
Flattening the curve of the virus’s progression will reduce the pressure on hospitals and save lives but will extend the time it takes for immunity to become common enough to slow the outbreak before a vaccine can be developed at the earliest in late winter.
“Until we get a vaccine, I think the estimates are like 40 to 70 percent of the population has to get sick [to develop immunity],” Landon said. “The area under the curve, for those of you who are studying [it], is the same whether you have a big high peak or whether you have a low peak that goes on. As high as that curve would have been without any intervention, it has to be at least that long.”
Landon warned that the coronavirus may present challenges beyond patient care. Mental health professionals are already seeing the effects of social isolation and heightened anxiety on their patients, which is a public-health issue that may worsen alongside the pandemic.
According to Landon, marginalized populations are hit hardest by coronavirus, because of their limited access to healthcare for preexisting conditions, and that many low-wage service workers are still working in essential industries with little protection. These factors divide patient outcomes for COVID-19 along the lines of class and race.
In addition, Landon said, it’s unclear who exactly is going to pay for coronavirus treatment and how much it will cost for UCMC’s uninsured and underinsured patients, and even those with health insurance.
“The hospital is working with insurers and the government to try and get good guarantees for people that this kind of care is going to be subsidized in some way,” Landon said. “We’ve got to make it so people are not penalized for becoming healthy, [so] there is not a cost to people to coming in and preventing spread to other people.”
Landon said that UCMC will soon have new tools at its disposal in the fight against coronavirus. The hospital is working on a serological (based on blood serum) test that detects antibodies in the blood from people who have already recovered from coronavirus, in order to measure how the virus spreads among asymptomatic people. UCMC hopes to soon start investigational use of convalescent serum treatment, which uses plasma from recovered COVID-19 patients as a source of antibodies for severely ill patients.
UCMC has already been testing experimental drug treatments for COVID-19, such as the Ebola antiviral remdesivir and the malaria drug hydroxychloroquine, which has been promoted by President Donald Trump. Landon said that remdesivir is showing promising results, while hydroxychloroquine “has not been particularly successful” when used on severely ill patients but may show more success in slowing the disease in earlier stages of infection, which could significantly improve the odds of recovery for high-risk patients and reduce the need for social distancing. However, Landon pointed to hydroxychloroquine’s potentially dangerous side effects as a reason to be wary when recommending its use.
“Widespread use of something that has not been proven is not a good idea,” Landon said. “I can’t really blame the president for wanting it to work, but I do not think that it’s wise to tell people to go out and just take it.”
In an emergency situation where there is a surge in patients, Landon predicted, UCMC could nearly double the number of hospital beds it had available and take other measures to increase its capacity.
For the moment, however, her outlook is cautiously optimistic.
“We are as ready as we possibly can be,” Landon said. “We are ready for more than it looks like we’re going to see, that’s the good news. But that’s a ‘today answer.’”