Combating COVID-19: An Interview with Angela Rasmussen, PhD.

Angela Rasmussen, PhD , is a virologist and Associate Research Scientist at the Center for Infection and Immunity at the Columbia Mailman School of Public Health. She studies the host response to emerging viral pathogens, including influenza, Ebola and SARS-CoV-2.

HISTORIANSPEAKS: Can you tell our readers about what experiences inspired you to pursue a career as a virologist?

RASMUSSEN: I got extremely sick when I was 10 with pneumonia, and subsequently developed asthma. At the time I was amazed how pathogens too small to see could cause me to become that ill and became interested in microbiology. In college, I read the Hot Zone, which is very cliché, but that did pique my interest in viruses. When I went to graduate school, I decided to complete my thesis in a virology lab.

HISTORIANSPEAKS: Can you provide an overview of what we currently know about COVID-19, how it functions and its impact on the body’s vital organs? Is the virus aerosol?

RASMUSSEN: The virus does appear to be transmitted by inhalation of droplets and aerosols, as well as by touching contaminated surfaces. COVID-19 was first thought to be primarily a respiratory disease, but we also have since seen that it can affect many other organ systems. We do not know if it damages those other organs by direct infection, or because of inflammation. We have a lot more work to do to understand how this works.

HISTORIANSPEAKS: How does COVID-19 manifest in human beings and what are its long and short-range effects? Some patients seem to have relatively mild symptoms, while others are severely ill and incubated. What factors account for these vast differences?

RASMUSSEN: It is thought that severe COVID-19 is caused by an out-of-control inflammatory response combined with suppression of the body’s own innate antiviral defenses. We don’t know what makes that more likely in one patient than another, but it’s probably a combination of factors: genetics, epigenetics, environment, diet, exposure, medical status at the time of infection, and access to health care all likely play a role. This combination of variables makes it exceedingly difficult to predict how severe a case will be.

HISTORIANSPEAKS: Do you think that cities and states which reopened too quickly are now paying the price in terms of increased cases, hospitalizations, and deaths? What alternative strategies could have stemmed this tide?

RASMUSSEN: Absolutely. Reopening too quickly is the primary driver of the surge in cases in the US. Alternative strategies that could have stemmed the tide include much slower reopening with two other components: 1. a clear message about public health precautions needed to keep community transmission low such as masks, physical distancing, avoiding crowds, avoiding enclosed spaces, and hand hygiene; 2. Increased testing and contact tracing capacity.

HISTORIANSPEAKS: As school systems around the country ponder whether to pursue in-class, on-line or hybrid models, what do we know about the impact of COVID-19 on children (K-12)

RASMUSSEN: We are still learning a lot about this, but children can be infected with SARS-CoV-2 and they can transmit it to others. Children are less likely to develop severe disease, but they can in some cases get extremely sick from COVID-19 and, rarely, can die from it.

HISTORIANSPEAKS: What treatments have proven more and less effective in treating this virus?

RASMUSSEN: Remdesivir has a very modest effect on COVID-19, but it can reduce the length of time a patient stays in the hospital. Dexamethasone, a corticosteroid, has been shown to improve outcomes in people who have severe COVID-19, probably by suppressing the inflammatory responses that cause pathology late in the disease. However, neither of these are ideal. Remdesivir is expensive and it is not practical or cost-effective to treat people early in the disease course when it is likely to be most effective. Dexamethasone is a potent immunosuppressant, so it can only be given to late-stage patients and could make disease worse if used in patients that are not extremely sick. Hydroxychloroquine does not appear to work at all based on numerous studies. We need to continue clinical trials on other candidate therapies to find more effective treatments.

HISTORIANSPEAKS: How does testing for COVID-19 work? What types of tests exist? Has the partnership between public and private labs been effective in the production and availability of tests? How effective have these tests been in identifying the presence of the virus and providing timely information to public health officials?

RASMUSSEN: Testing for COVID-19 uses a test called quantitative reverse transcriptase-polymerase chain reaction or qRT-PCR. This measures the presence and amount of viral RNA (the virus’s genetic material). Our testing capacity is still not where it needs to be, as shown by high positivity rates and long turn-around times. We really need new tests to further increase capacity, including at-home tests that people can use to assess whether they are positive and might be contagious.

HISTORIANSPEAKS: Why is the public health system in the United States so ill-prepared to address this pandemic?

RASMUSSEN: President Trump disbanded the federal panel overseeing pandemic preparedness and has fomented distrust of science and made it a political issue. As a result, trust in public health authorities has been greatly eroded, which is the exact opposite of what you want in a response to a pandemic. Furthermore, this politicization means that we have not provided the needed social safety nets to help people economically through this. People cannot stay home if their jobs and livelihoods are at stake. I deeply hope that we will learn our lesson about the dangers of politicizing pandemics.

HISTORIANSPEAKS: What should public health officials do to effectively alert and educate the public about the harmful effects of COVID-19?

RASMUSSEN: We need public health officials to put forth a clear, united message on how to reduce community transmission (stay home if possible, wear masks, avoid crowds, wash hands) and we need them to stop being undermined by state and federal political leadership.

📷