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Q&A

Mark McClellan is the founding director of the Duke-Margolis Center for Health Policy and former commissioner of the Food and Drug Administration. What does the fall season look like with the coronavirus?

I’m cautiously optimistic. That said, we need to prepare for a potential additional wave. That’s been the feature of previous pandemics, and there also are a lot of reasons to think there could be a bigger surge in cases in the fall, with the return to school, with changes in the weather, and with outbreaks that are still very active in other parts of the world. We are reopening in the U.S., and we’re definitely seeing outbreaks associated with reopening.

Is it likely that the virus might have been around for a long time without conspicuously infecting humans? The virus probably was around in the animal community for some time. Genetic testing and studies of animal populations in China, where we think the virus arose, will help address that question. We also are getting very good at doing genetic tests of the different viral variants that are present in different places around the world, which can help us understand how the virus actually spreads. In the western U.S., it looks

antibody levels over time. And then what you’d really like to know is not just what the antibody levels are, but is there any evidence that those individuals either get reinfected or could potentially transmit the virus again? That means doing that other kind of test, the diagnostic test for whether you’ve got an active viral infection, on those same individuals over time. If it’s like other coronaviruses, at least for people who had a significant infection and mounted a significant response, the response should be present for a while,

The public-health impact and the economic impact of COVID-19 is way bigger than any infectious disease that we’ve seen in a long time. How does this novel coronavirus differ from SARS and MERS, two earlier pathogens?

They are very different. I was FDA commissioner during the SARS outbreak. We did see significant outbreaks in places like Singapore, Hong Kong, and Taiwan; as a result of that experience, they built much stronger public-health surveillance systems to prevent future outbreaks. The SARS outbreak was contained essentially because it did not spread so easily. While the cases of SARS and MERS tended to be more severe, the number of cases and the transmissibility makes COVID-19 much more challenging to manage.

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like the spread from China was initially important. In the eastern U.S., it spread from Europe with slightly different genetic variants. I don’t think that’s a reason to worry, by the way, that the virus is mutating so that it won’t respond to that potentially effective vaccine or other treatments.

Will we ever know whether people are protected from the coronavirus after having been infected by it?

I hope so. What you need to do is identify a whole population of people who have been exposed to the virus and have recovered and measure their antibody levels—that’s the serology test—and then track those

maybe not years, but at least long enough to get through this vaccine season. It does look like, from other coronaviruses, that some of that immunity should persist for a while.

Why is it that some people cope easily with the disease and may not ever know they have it, while others develop severe inflammation, lung damage, and so forth? This is still a relatively new and not-well-understood virus. It does appear that one of the factors in the intensity of the response is not the virus itself but the body’s immune reaction to the virus. It looks like blood type matters, that men apparently do worse than women, and

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