The New York Times - USA (2020-06-25)

A8 N THE NEW YORK TIMES, THURSDAY, JUNE 25, 2020

Tracking an OutbreakGlobal Response

ready, in Britain, some local offi-
cials say their efforts are not co-
ordinated enough.
The shifting strategies are an
acknowledgment that even the
most successful countries cannot
declare victory until a vaccine is
found. They also show the chal-
lenge presented by countries like
the United States, Brazil and In-
dia, where the authorities never
fully contained initial outbreaks
and from where the coronavirus
will continue to spread.
“It’s always going to be with us,”
said Simon James Thornley, an
epidemiologist from the Univer-
sity of Auckland in New Zealand.
“I don’t think we can eliminate the
virus long term. We are going to
need to learn to live with the vi-
rus.”
Even in places where the coro-
navirus appeared to be under con-
trol, big outbreaks remain a major
risk. In Tokyo, there have been
253 new infections in the past
week, 83 from a nightlife district.
In Gütersloh in western Germany,
more than 1,500 workers from a
meat processing plant tested pos-
itive, prompting the authorities to
shut down two districts. South Ko-
rea has announced dozens of new
infections in recent days.
In Rome, which recently
emerged from one of the strictest
lockdowns in Europe, 122 people
have been linked to a cluster case
at a hospital, the San Raffaele Pi-
sana Institute. Several days later,
18 people who lived in a building
with shared bathrooms came
down with the virus.
“As soon as we lowered our
guard,” said Paolo La Pietra, who
owns a tobacco shop in the neigh-
borhood, “it hit us back.”
Some countries, like South Ko-
rea and Japan, aimed to make
their responses nimble.
South Korea calls its strategy
“everyday life quarantine.” The
country never implemented the
strict lockdowns seen in other
places, and social-distancing
measures, while strongly encour-
aged, remain guidelines. Still, it
has set a strict target of a maxi-
mum of about 50 new infections a
day — a target that it says its pub-
lic health system, including its
testing and tracing capacity, can
withstand.
Officials shift the rules as
needed. After a second wave of in-
fections broke out in Seoul, city of-
ficials made people wear masks in
public transportation and closed
public facilities for two weeks.
The South Korean government
has added new guidelines as it has
learned more about outbreaks. It

advises companies to have em-

ployees sit in a zigzag fashion. Air-

conditioners should be turned off

and windows opened every two

hours to increase ventilation, it

said. It has discouraged singing in

markets and other public places.

It has also advised people to

carry two types of masks in sum-

mer — a surgical mask and a

heavy-duty mask, similar to the

N95 respirator masks worn by

health care workers, to be used in

crowded settings.

Japan, which endured only lim-

ited lockdowns, also wants to keep

its limits light to help restart its

economy. It is considering allow-

ing travelers from Australia, New

Zealand, Thailand and Vietnam.

As an island nation, Japan cannot

afford to keep its borders closed,

Prime Minister Shinzo Abe said.

Last Friday, Japan launched a

contact tracing app that would

alert users if they had been in

touch with a person who tested

positive in the last 14 days. Rail-

way operators have launched an

app and websites telling commut-

ers how crowded the trains are.

Officials are also warning peo-

ple constantly to change the way

they live. Though bars and clubs

are reopening, hostesses have

been told to refrain from being

next to a client when singing kara-

oke and dancing. Nightclubs must

minimize music and crowd vol-

umes to reduce the spread of res-

piratory droplets. Citizens are ad-

vised to continue avoiding the

“Three Cs” — closed, crowded and

close-contact activities.

“We need to run the economy

strongly by controlling the infec-

tion risks with less-restrictive

measures and take measures

which put more emphasis on pro-

tecting jobs and life,” said Mr. Abe.

Some countries, like China, are

learning to ease their more draco-

nian methods. The Chinese gov-

ernment virtually isolated tens of

millions of people in the city of Wu-

han and surrounding Hubei Prov-

ince when the outbreak began.

Mindful of the economic dam-

age, Chinese leaders have

adopted looser restrictions. In

Beijing, officials told residents

that they could take off their

masks outdoors. Temperature

screening in the city became less

widespread.

Then, on June 12, Beijing offi-

cials announced that 53 people

had tested positive for the coro-

navirus. Instead of locking up the

capital city, officials promptly shut

down a market and residential

communities surrounding it and

mobilized close to 100,000 com-

munity workers to test roughly 2.

million residents in about a week.

“A city as big as Beijing can’t be

in a state of wartime resistance

forever,” said Mao Shoulong, a

public policy professor at Beijing’s

Renmin University. “How many

more times can we endure this?”

Unlike Wuhan, the effort was

targeted. Other Beijing neighbor-

hoods stayed open. The Chinese

government tends to favor mass

testing focused on specific groups

— in addition to the people con-

nected to the market, it said it

would also test residents living in

high- and medium-risk neighbor-

hoods, restaurant and retail staff,

students and teaching staff, and

health care workers.

China’s strategy is not to bring

infections to zero, said Zhang

Wenhong, an adviser to the

Shanghai government on the pan-

demic. Instead, in an interview

with China’s Caixin magazine, he

described China’s game plan as

“getting close to zero cases.”

“Prevention and control with

precision, coupled with rapid

medical treatment,” Dr. Zhang

said. “This strategy will be appli-

cable to China for a long time.”

European governments are

also learning to be more flexible

following their strong responses,

though the process can be slow. In

Germany, officials have stipulated

that regions or municipalities that

register more than 50 new infec-

tions per 100,000 people in seven

days must quickly respond to

quell the outbreak, using tools like

school closings, full quarantines

and mass testing.

Though many of these efforts

are intensely local, they require

close coordination with central of-

ficials and neighboring jurisdic-

tions. England, for example, is ex-

ploring limited, tailored shut-

downs around clusters of infec-

tions, but local officials warn of

potential holes in the system.

Health officials in England,

Wales, Scotland and Northern Ire-

land are largely responsible for

their own strategies. In England,

where local officials have com-

plained about a lack of testing

data from the central government,

employers or building managers

have picked up the slack by keep-

ing track of infections and re-

spond to outbreaks. Some, like the

headquarters of a major retailer in

East Lancashire, have been

praised by public health officials

for taking quick action.

But controlling the virus would

require an understanding of

where it is lurking, especially diffi-

cult for a disease in which 80 per-

cent of the cases have mild symp-

toms. Several local public health

directors said in interviews that

they learned about outbreaks

from the news. The level of detail

that officials need to decide on lo-

calized shutdowns — the postal

codes of people testing positive,

for example — remains elusive.

“Every pandemic begins as a lo-

cal outbreak,” said Lincoln

Sargeant, the director of public

health in North Yorkshire. “It’s

granular intelligence that we need

in a timely fashion.”

Mr. Johnson, the prime min-

ister, has maintained that local

shutdowns are sufficient to con-

trol new waves of the virus. In the

beginning, the government “had

very few instruments at our dis-

posal,” he said on Friday. Now, he

said, officials can “identify out-

breaks where they happen.”

He has likened the effort to

Whac-a-Mole, the arcade game.

Officials can “take the preventive

measures necessary on the spot,

rather than going back to the na-

tional lockdown approach,” he

said. “That’s what we hope.”

In Rome, the outbreak at the

San Raffaele Pisana Institute

tested the ability of local authori-

ties to find and stop outbreaks.

Local health officials tested pa-

tients and hospital workers, emp-

tied three wards and sealed off the

building. Former patients and

their contacts queued in their cars

outside drive-in testing stations.

Rome’s prosecutors opened an in-

vestigation into clusters’ origin.

One of the people who became

ill was a pulmonologist, Vittorio

Bisogni. He came down with a

slight fever after he visited a pa-

tient who had been released from

the hospital. Dr. Bisogni was diag-

nosed with the virus on June 9. His

patient died a few days later.

“I got angry,” Dr. Bisogni said,

“After getting hit so hard, we can’t

afford to be so naïve.”

THE NEW NORMAL

Unable to Eradicate Covid-19, the World Is Learning to Live With It

In Beijing this week, above, officials reacted to a new outbreak by

isolating a market and the surrounding areas while testing over

two million people in about a week. In Seoul, left, the authorities

are initiating actions that they call “everyday life quarantine.”

KEVIN FRAYER/GETTY IMAGES

JUNG YEON-JE/AGENCE FRANCE-PRESSE — GETTY IMAGES

From Page A

Reporting was contributed by
Hisako Ueno from Tokyo, Su-Hyun
Lee from Seoul, South Korea, and
Christopher F. Schuetze from
Berlin. Liu Yi contributed re-
search.

MOSCOW — To the boys, it was
just a sugary treat. To their par-
ents, prominent medical re-
searchers, what happened in their
Moscow apartment that day in
1959 was a vital experiment with
countless lives at stake — and
their own children as guinea pigs.
“We formed a kind of line,” Dr.
Peter Chumakov, who was 7 at the
time, recalled in an interview. Into
each waiting mouth, a parent
popped a sugar cube laced with
weakened poliovirus — an early
vaccine against a dreaded dis-
ease. “I was eating it from the
hands of my mother.”
Today, that same vaccine is
gaining renewed attention from
researchers — including those
brothers, who all grew up to be vi-
rologists — as a possible weapon
against the new coronavirus,
based in part on research done by
their mother, Dr. Marina Voroshi-
lova.
Dr. Voroshilova established that
the live polio vaccine had an unex-
pected benefit that, it turns out,
could be relevant to the current
pandemic: People who got the
vaccine did not become sick with
other viral illnesses for a month or
so afterward. She took to giving
the boys polio vaccine each fall, as
protection against flu.
Now, some scientists in several
countries are taking a keen inter-
est in the idea of repurposing ex-
isting vaccines, like the one with
live poliovirus and another for tu-
berculosis, to see if they can pro-
vide at least temporary resistance
to the coronavirus. Russians are
among them, drawing on a long
history of vaccine research — and
of researchers, unconcerned

about being scoffed at as mad sci-

entists, experimenting on them-

selves.

Experts advise that the idea —

like many other proposed ways of

attacking the pandemic — must

be approached with great caution.

“We are much better off with a

vaccine that induces specific im-

munity,” Dr. Paul A. Offit, a co-in-

ventor of a vaccine against the ro-

tavirus and professor at the Perel-

man School of Medicine at the

University of Pennsylvania, said

in a telephone interview. Any

benefits from a repurposed vac-

cine, he said, are “much shorter

lived and incomplete,” compared

with a tailored vaccine.

Still, Dr. Robert Gallo, a leading

advocate of testing the polio vac-

cine against coronavirus, said that

repurposing vaccines is “one of

the hottest areas of immunology.”

Dr. Gallo, director of the Institute

of Human Virology at the Univer-

sity of Maryland School of Medi-

cine, said that even if the weak-

ened poliovirus confers immunity

for only a month or so, “it gets you

over the hump, and it would save a

lot of lives.”

But there are risks.

Billions of people have taken

live poliovirus vaccine, nearly

eradicating the disease. However,

in extremely rare cases, the weak-

ened virus used in the vaccine can

mutate into a more dangerous

form, cause polio and infect other

people. The risk of paralysis is es-

timated at one in 2.7 million vacci-

nations.

For those reasons, public health

organizations say that once a re-

gion eliminates naturally occur-

ring polio, it must stop routine use

of oral vaccine, as the United

States did 20 years ago.

And this month, the National In-

stitute of Allergy and Infectious

Diseases delayed a study de-

signed by Dr. Gallo’s institute, the

Cleveland Clinic, the University of

Buffalo and Roswell Park Com-

prehensive Cancer Center to test

the effectiveness of live polio vac-

cine against coronavirus, using

health care workers as subjects.

The agency raised safety con-

cerns, including the chance of live

poliovirus making its way into wa-

ter supplies and infecting others,

according to researchers familiar

with the study application. The

press office of the N.I.A.I.D. de-

clined to comment.

But other countries are moving

ahead. Trials with the polio vac-

cine have begun in Russia, and are

planned in Iran and Guinea-Bis-

sau.

A specific vaccine for the coro-

navirus would be one that trains

the immune system to target that

virus specifically, and more than

125 vaccine candidates are under

development around the world.

Repurposed vaccines, in con-

trast, use live but weakened vi-

ruses or bacteria to stimulate the

innate immune system more

broadly to fight pathogens, at

least temporarily.

The first polio vaccine, devel-

oped by Dr. Jonas Salk, an Ameri-

can, used “inactivated” virus —

particles of killed virus. It had to

be injected, an obstacle to immu-

nization campaigns in poorer

countries.

When that vaccine was widely

introduced in 1955, Dr. Albert Sa-

bin was testing a vaccine using

live but attenuated poliovirus,

which could be taken orally. But in

the United States, with the Salk

vaccine already in use, the au-

thorities were reluctant to take

the perceived risk of conducting

live-virus trials.

Dr. Sabin gave his three strains

of attenuated virus to a married

pair of virologists in the Soviet Un-

ion, Dr. Mikhail Chumakov, the

founder of a polio research insti-

tute that now bears his name, and

Dr. Voroshilova.

Dr. Chumakov vaccinated him-

self, but a medicine intended pri-

marily for children needed child

test subjects, so he and Dr. Voro-

shilova gave it to their three sons

and several nieces and nephews.

Their experiment enabled Dr.

Chumakov to persuade a senior

Soviet official, Anastas Mikoyan,

to proceed with wider trials, even-

tually leading to the mass produc-

tion of an oral polio vaccine used

around the world. The United

States began oral polio vaccina-

tions in 1961 after it was proved

safe in the Soviet Union.

“Somebody has to be the first,”

Dr. Peter Chumakov said in an in-

terview. “I was never angry. I

think it was very good to have

such a father, who is confident

enough that what he is doing is

right and is sure he will not harm

his children.”

His mother was, if anything,

even more enthusiastic about run-

ning the tests on the boys, he said.

“She was absolutely sure there

was nothing to be scared of,” he

said.

Something Dr. Voroshilova no-

ticed decades ago has renewed in-

terest in the oral vaccine.

A typical healthy child is host to

a dozen or so respiratory viruses

that cause little or no illness. But

Dr. Voroshilova could not find any

of them in children soon after they

were immunized against polio.

A Soviet Union study of 320,

people, from 1968 to 1975, over-

seen by Dr. Voroshilova, found re-

duced mortality from flu in people

immunized with other vaccines.

Dr. Voroshilova’s and Dr. Chu-

makov’s work clearly influenced

their sons’ minds as well as their

health — not only did all of them

become virologists, they em-

braced self-testing as well.

Dr. Peter Chumakov today is

the chief scientist at the Eng-

elhardt Institute of Molecular Bi-

ology at the Russian Academy of

Sciences and co-founder of a com-

pany in Cleveland that treats can-

cer with viruses. He has devel-

oped about 25 viruses for use

against tumors — all of which, he

said, he has tested on himself.

He is also now taking polio vac-

cine, which he grows in his own

laboratory, as possible protection

against coronavirus.

Dr. Ilia Chumakov, a molecular

biologist, helped sequence the hu-

man genome in France.

Dr. Alexei Chumakov, who was

not yet born when his parents ex-

perimented on his brothers,

worked as a cancer researcher at

Cedars-Sinai in Los Angeles for

much of his career. While working

in Moscow, he developed a vac-

cine against hepatitis E, which he

tested first on himself.

“It’s an old tradition,” he said.

“The engineer should stand under

the bridge when the first heavy

load goes over.”

Dr. Konstantin Chumakov is an

associate director of the U.S. Food

and Drug Administration’s Office

of Vaccine Research and Review,

which would be involved in ap-

proving any coronavirus vaccines

for use in Americans.

In an interview, he said he can-

not remember eating the sugar

cube back in 1959 — he was 5

years old — but approved of his

parents’ experiment as a step to-

ward saving untold numbers of

children from paralysis.

“It was the right thing to do,” he

said. “Now, there would be ques-

tions, like ‘Did you get permission

from the ethics committee?’ ”

IMMUNIZATION

Soviet-Era Studies Offer

Possible Path to Vaccine

The virologists Dr. Marina Voroshilova, left, and Dr. Mikhail Chumakov, second from left, in 1956.

BETTMANN ARCHIVE

By ANDREW E. KRAMER

Oleg Matsnev contributed report-
ing from Moscow.