Thomas File, Jr. MD, MSc, FIDSA, president of the Infectious Diseases Society of America, weighs in on COVID vaccine development, fears of a second wave, and treatment candidates.
Segment Description: Thomas File, Jr. MD, MSc, FIDSA, president of Infectious Diseases Society of America (IDSA), chair of the Infectious Disease Division, and co-director of the Antimicrobial Stewardship Program at Summa Health in Ohio, discusses IDSA’s role in the COVID-19 pandemic.
Interview transcript (modified slightly for readability):
Contagion®: Hi, I’m Allie Ward, editorial director of Contagion®. Joining me today is Dr. Thomas File, president of the Infectious Diseases Society of America, chair of the Infectious Disease Division, and co-director of the Antimicrobial Stewardship Program at Summa Health in Ohio.
Dr. File, let’s jump right in. IDSA has been at the forefront of the COVID-19 pandemic since the beginning, continuously setting and updating guidelines, as well as weighing in on some of the debate surrounding aspects of public health’s management of COVID. Can you talk a bit about IDSA’s role in this pandemic?
Thomas File, Jr. MD, MSc, FIDSA: Thank you Allie, for having me, and sure, I'd love to do this. As you can appreciate, all of our members and our staff have been working tirelessly almost 24/7 on this pandemic for the last 6 months really. I can remember very vividly getting an email on January 21 actually from one of our ID colleagues, who's a member of IDSA, who had just admitted at the time the first patient with COVID-19 or infection due to SARS-CoV-2 to a hospital in Washington and of course that started multiple patients that we've seen since then. But literally, since then and into February, our volunteer members of IDSA, our staff of our association have pivoted away from non-COVID activities to almost 24/7 working on COVID.
As you said, we've been working almost on all aspects. Many of our members are involved in research for antivirals, for developing vaccines. We've been working very hard in the public health sector—many of our members are public health experts—we've been working very extensively in education, educating the public, educating our colleagues. But most importantly, actually taking care of patients. We have a membership of over 12,000 infectious disease specialists and scientists and researchers and public health experts and other health professionals all involved in the care of patients with infectious diseases. Basically, we've all been working on this COVID pandemic since that time.
Now, as you mentioned, our society has done many things on our website to develop protocols, to develop policies. We've developed a variety of telebriefings to help educate the public and the media. We've developed very significant rapid guidelines for our members and for everybody else caring for these patients. We have guidelines for management and treatment, guidelines for infection control, and guidelines for diagnostic testing. And these are live guidelines. They're living documents so we're changing them and we're already updating the management and treatment guidelines as we see new information coming together. We've been had to be in significant communication with government, with policymakers, both national and the state and local level, to make sure that we're getting the best information so that our patients are being appropriately treated. We're working very closely with US Centers for Disease Control and Prevention (CDC) and National Institutes of Health (NIH). We've developed a learning network with CDC. As you can see, our society has been very active. We're working very tirelessly, but that's our mission. We want to make sure that we provide the best care for our patients. We all have to collectively work to respond appropriately to this pandemic.
Contagion®: In formulating guidelines, how challenging has it been to keep up with the volume of news and data regarding COVID? What advice do you have for clinicians in the field trying to keep up on the latest developments?
File: Now, Allie, that's absolutely appropriate. Almost there's new information daily, and it's really important that we have accurate information and not misinformation, unfortunately, which can sometimes happen, particularly on social media and it can be disseminated so. As you're even aware, some of the studies that have been published had to be retracted because we have to just make sure that information that is being disseminated is appropriate and that it is the best for care of our patients. It's vital that we all have sources of very accurate information. Obviously, IDSA has a very active website. We have a COVID resource center there that has all kinds of information. There's a directory, whether you want to go to various guidelines or if you want to go to protocols from other institutions to see how they're handling personal protective equipment (PPE) and contingency assessment. There’re telebriefings, there’re podcasts, we have blogs on our website. So we have all kinds of sources of information that can be accessed through our website, which is IDsociety.org.
Contagion®: Last week, the US Food and Drug Administration (FDA) revoked the emergency use authorizations for hydroxychloroquine and chloroquine. IDSA put out a statement supporting the decision. Can you talk a bit about how did the organization came to its conclusion there?
File: If you look at the FDA site, they indicate that their decision was based on new information, which suggested—and we agree with that— that suggests that there's really no significant benefit of these 2 drugs in patients who are infected with SARS-CoV-2 or who have COVID-19.
Literally in the last week, 2 very large studies—I'm talking about tens of thousands of patients that are enrolled in these studies…One is a recovery study that's overseen by investigators in Oxford, England. And then the SOLIDARITY study, which is overseen by the World Health Organization (WHO) both suspended or halted recruitment into studies where they were evaluating hydroxychloroquine. Why? Because in their assessment, they really did not find any benefit. And then also there was a study that was published out of University of Minnesota showing that patients who were exposed to COVID-19 and then given hydroxychloroquine really had no benefit in preventing infection. We have robust data now, which suggests that there just isn't a significant benefit at all of hydroxychloroquine. It certainly was our assessment as well at IDSA. We're going to be showing that in our updated guidelines as well, that there's just really no benefit of these 2 agents.
Contagion®: News broke this week that investigators in the UK saw some success with a cheap and widely available steroid in terms of reducing mortality in patients with COVID-19. What was your reaction to that news and do you consider dexamethasone a viable treatment candidate?
File: Anytime we get good news, and there's data that suggests that there's interventions that can be helpful to our patients, we certainly welcome that. Again, this is from the same adaptive study that I just mentioned, that recovery study that's overseen by investigators in Oxford, England. This is a preliminary report, we haven't seen the published data, so we have to really look at the published data. But it's the use of dexamethasone, particularly in patients who are fairly severely ill and have significant illness often requiring mechanical ventilation. And that's important because, up until now, there's been a question about what interventions can be valuable in these patients who now are to the stage where now they're on the ventilator, perhaps developing acute respiratory disease syndrome (ARDS). The fact that there's a study that suggests that there's benefit is very helpful. We still have to wait to see the peer-reviewed published data, but I'm certainly encouraged by this initial information.
Contagion®: Switching gears to vaccination…Are you encouraged by some of the progress being made on vaccine development for COVID-19?
File: I'm encouraged by that as well. I'm a very optimistic person, actually. At least when I hear about the progress that a variety of investigators and developers are having with their development of a specific vaccine—and there are several that are in evaluation right now different platforms for the vaccines—I'm encouraged because it looks like they're going to already be starting phase 3 studies next month. Hopefully these can be geared up and show definite benefit and be shown to be very, very safe.
What's the earliest that could be available? I don't know. I mean, people say possibly by the end of the year. I think that's very, very optimistic. But certainly, if we can get it within a year, from the standpoint of vaccine development, that is very, very quick. It's really going to be important because until we can have a vaccine and therefore have a large segment of the population receive this vaccine, therefore have herd immunity, it's going to be very difficult to control this pandemic.
Contagion®: From your perspective, what has been the biggest obstacle in navigating this pandemic?
File: When I think about that, there's probably several. I think right now the biggest issue is what I'm going to call, and what others have called, “COVID fatigue.” So much of the population has been in stay-at-home mode or shelter-in-place mode for a couple months. Now, the weather's nicer, communities are opening up, restrictions are reduced, and people are outside. They want to perhaps remove their masks, forget about social distancing, and that is not good. That's going to jeopardize being able to safely open up the community. I think we have to provide good guidance that says, when we're opening up, we still have to practice these good health measures, such as physical distancing, such as wearing masks, such as hand hygiene, such as disinfection. That's extremely important, or else we're going to jeopardize opening up the communities. And some states have seen a significant spike in cases as they're opening up. That's the worst that we could see if we have to lock down again, and we don't certainly want to do that. I think what I'm going to call “COVID fatigue” is a big issue and we have to try to maintain good practices and promote this to the general public.
I think other issues of concern is we still probably don't have the adequate testing that we need. Until we can have adequate, easily accessible testing, and then you can do contact tracing so we can go back into this mode of containment, so that we identify patients, we identify who's in contact with them, we can quarantine them or self-monitor them, so that we can contain further transmission. That's going to be extremely important.
From a standpoint of workforce, I'm going to say a barrier is that we just don't have enough of us. We don't have enough public health experts; we don't have enough people who actually are going to be required to do the contact-tracing. There's one study that suggests we probably need at least 300,000 in the United States to do that adequately, and we just don't have that right now so we have to ramp up. This is a potential obstacle if we're going to be able to continue to contain this pandemic as best as possible.
Contagion®: Concerns over a “second wave” are mounting as we approach fall and the start of flu season. How serious could this second wave be and what can clinicians do to ensure the public is aware of this threat?
File: I think that's a great concern. There're many potential scenarios as to what's going to happen with this pandemic, but I have to think that the most common is that we're going to continue to see low level of activities, and maybe general occasional spikes as we go through the summer. But then the great concern is that when we go into the late fall or early winter, the respiratory season, we're going to see another surge. If you look at the history of pandemics, that's what's happened, I mean, even the 1918-1919, even the 2009-2010 pandemic with H1N1, it started in the late winter, early spring, but then the next winter it was even worse and so we have to be concerned about that. And then like you said, if this occurs at the same time as influenza, it could even be worse because we do know that dual infections, even dual viral infections, can be associated with greater morbidity and, unfortunately, mortality. What should we do? Well, again, we have to be prepared for that. Hopefully, we'll have some antiviral medicines that we've already mentioned. But again, we're going to have to be very, very stringent on maintaining the health measures that I've mentioned and using the masks. When people go back into colleges and businesses or whatever, we're going to have to wear the mask, we're going to have to physical distance as best as possible, and practice hand hygiene, so we're just going to have to be very aware of that and promote that as best as possible until we have that vaccine.
Contagion®: What is your message to your peers and colleagues in infectious disease during this time?
File: Those of us in infectious disease, we've been working tirelessly 24/7 to control this pandemic, and I'm so proud of all my friends and colleagues who are doing this and, in many cases, even putting their lives at risk, their families at risk, but they're doing this because they know that this is best for the community, this is the best for their patients. This is our mission. I'm very proud of our colleagues who are involved in this case against this pandemic. Collectively, let me just say this: If we all work together, we are going to get through this. So thank you to every one of you who are working tirelessly to manage this pandemic.