Marin epidemiologist Larry Brilliant: Virus crisis just beginning

Marin Independent Journal (CA)

Jun. 7--World-renowned epidemiologist Dr. Larry Brilliant of Mill Valley is warning that now is not the time for complacency in the battle against the coronavirus.

"Marin is nowhere near out of the woods," Brilliant said during a briefing of Marin County's Commission on Aging conducted by teleconference Thursday.

Brilliant is the advisory board chairman of the nonprofit Ending Pandemics, a spinoff of the Skoll Global Threats Fund, for which Brilliant was CEO.

He said the coronavirus is continuing to spread in Marin and the rest of the world at an alarming rate and appears to have a fatality rate of 5%, making this pandemic worse than the influenza pandemic of 1918.

"We have not gone over a peak," Brilliant said. "We have not even passed the first wave. We are early in this pandemic."

He said the virus is spreading exponentially, with each person who contracts it passing it on to between two and 2.4 people on average. The World Health Organization, which Brilliant worked with on an effort to eradicate smallpox, has projected that the coronavirus pandemic will hit new highs next week, with 7 million people infected and 400,000 deaths globally.

"And to our shame," Brilliant said, "the United States accounts for more than a quarter of all the deaths in the world."

He said most of the hot spots in the United States are in politically "red" states, which favored Donald Trump in 2016. Brilliant said areas where the infection rate is doubling every three or four days include: Alabama, Mississippi, Georgia, southern Florida, North Carolina, South Carolina, Arizona, Arkansas and parts of Texas.

"These are all places that were overeager to open up," he said.

Brilliant said Marin County shows up as a "warm spot" on the New York Times' map of the virus' spread.

"We are today at the highest rate of COVID that we've had," he said, regarding Marin. "We are in the second most dangerous category."

Nevertheless, Brilliant praised Marin County Public Health Officer Dr. Matt Willis and Gov. Gavin Newsom for their response to the pandemic so far.

"I'm glad that we're moving at a thoughtful, measured pace to reopen the county," he said. "They're really using a fact-based approach, which isn't true of many other places."

Brilliant added, however, "I'm worried that whatever our plan is we're going to get overrun by national trends."

He cited the recent mass protests following the death of George Floyd and the decision of many states to lift stay-at-home orders around Memorial Day as events that could imperil plans to reopen.

"My heart goes out to the protesters in the street," Brilliant said. "My first reaction when I see them is, thank God people are taking racism seriously enough to go out into the streets, but that is followed a second later by ... look at the ones who don't have masks on."

He said wearing a mask is the most impactful action people can take to quell the spread of the virus, with hand washing coming in second.

"If 80% of people wore a mask 80% of the time, COVID would go away," Brilliant said.

Lee Pullen, director of Marin County's Aging and Adult Services division, said the commission's members were eager to learn more about the pandemic and its particular effects on older adults. Brilliant's wife, Girija Brilliant, is a member of the commission.

Pullen asked Brilliant's advice on how to balance the negative consequences of isolating older adults in assisted living and skilled nursing homes against the risk of contracting the virus.

Brilliant said a quarter of COVID-19 deaths in the U.S. have occurred in nursing homes. He said because the living quarters are often cramped, each person in a nursing home who contracts the disease spreads it to five other people on average.

He said it is unclear why the coronavirus is so much more lethal for people 65 or older. He said the initial explanation was that older people have weaker immune systems.

"Then they found that having a poorer immune system is in some ways protective against something called a cytokine storm," he said, "which is an immune system that gets over exuberant."

New research suggests that COVID-19 may be more of a disease of the blood vessels than the lungs, he noted.

He predicts that a vaccine for COVID-19 will be found, but it might require refrigeration -- making it difficult to distribute worldwide -- and regular booster shots.

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