CHAPEL HILL, N.C. — You should be nervous about this upcoming winter, with COVID-19 surging across the U.S., says Ralph Baric, a UNC professor who is one of the world's preeminent researchers of coronaviruses.
Things are likely to get much worse before they get better.
"We are looking at five months of extensive and rapid virus spread," Baric said in a phone interview with The News & Observer. "The good news is there is a light at the end of tunnel."
That light appears to be a new vaccine by Pfizer, which delivered promising results on its experimental vaccine this month. A number of other vaccines are being tested as well.
But they won't be ready for weeks or months and the weather is quickly getting colder, sending more Americans indoors to places where the virus may spread rapidly.
"I think it is important [to note] that before vaccines become widely delivered," Baric said, "that we are looking at about 250,000 more deaths in the U.S., despite the development of new drugs. That is probably going to still occur because of the massive increases in cases."
Nationwide, and in North Carolina, records are being set for daily positive coronavirus cases. On Friday, more than 181,100 new cases were reported across the country, a record that came only eight days after the U.S. reported its first 100,000-case day, The New York Times reported.
More than 244,000 people have died from COVID-19 in the U.S.
Perhaps more than half of those additional deaths can be avoided, Baric said, if people wear masks, practice social distancing and wash their hands frequently.
"But you have to wear masks the correct way — not just covering your mouth," he said. That is because COVID-19 actually grows fastest in people's noses and nasal cavities.
Baric has been studying coronaviruses for three decades, and he has been one of the scientists raising red flags for the longest about their potential to cause global pandemics. In March, his lab was one of the first to get a sample of SARS-CoV-2, the virus that causes COVID-19. It was also one of the first to conduct trials on remdesivir, the first treatment to be approved by the U.S. Food and Drug Administration for COVID-19.
Since March, Baric has spent nearly every day in his lab at the Gillings School of Global Public Health, studying the virus and conducting trials on potential treatments. He's also published more scientific papers this year than any other in his career, he surmised.
And after eight months of living with the virus in the U.S., he has good and bad news.
The good news: The current strain of the coronavirus in the U.S. is not mutating in a way that will reduce the effectiveness of vaccines being developed.
It is mutating, though. It is becoming more infectious — a definite problem in the near term as people gather indoors. But vaccines developed from samples taken in March should work. And the new mutation might be more vulnerable to vaccines.
That is according to a new paper by Baric and others, which looked at the dominant strain of the coronavirus in the U.S. That strain mutated likely in Italy, then spread to New York and the rest of the U.S.
But the virus becoming more vulnerable to vaccines happened by chance.
"It could easily have changed and become more resistant to a vaccine," Baric said. "That would have been a perfect nightmare."
And that still could happen, he warned.
"At some point as more and more people have been exposed and survived or been vaccinated," he said, "the selective pressure (to mutate) is going to increase. The virus might have to change to protect itself (and) to become less vulnerable or it has to figure out something else, like jump into a reservoir species."
That seems to be happening in Denmark at the moment — a matter of concern. In that Scandinavian country, an outbreak is occurring in a farmed mink population, and it is creating a new mutated strain. In response, the country plans to cull 15 million minks.
The minks appeared to have been infected by humans, and then stored the virus. After mutating, the virus transferred from minks back into humans. Since June, more than 200 human cases of COVID-19 in Denmark have been traced to farmed minks, including a dozen cases that had a unique variant, the World Health Organization said.
Baric said that in a preliminary test, the mink mutation appeared to be more resistant to antibodies. But these are very preliminary studies. Baric's lab and others will do more tests to validate the findings. David Montefiori, the director of the Laboratory for AIDS Vaccine Research and Development at Duke, said he is working on a synthetic version of that mink mutation and should know more about it in two weeks.
The mink mutation could be a problem.
"In general, the COVID-19 virus is a Southeast Asian virus," Baric said. "It only has come in contact with mammals that have lived in Southeast Asia. When the virus has gone global — and there are 50 million people with it on every continent — all sorts of mammals and bats are being exposed to it that have never seen it before. Some are going to become reservoirs. Even if we eliminated it in humans, it could hang out in another species in North America."
Baric knows he can sound overly negative. And there are some positive developments.
One is Pfizer's vaccine, which the company reported was 90% effective, far exceeding many expectations.
"This is really good data," he said of Pfizer's report. The crabby scientist in him still has worries about it, he said, namely that most of the infections studied by Pfizer were mild and that the pool of elderly and minority people in the trial was small.
But this is "absolutely good news," Baric said. "There's more important data that will come in the [coming] months, and if it is as encouraging [as Pfizer's], we are probably looking at the pandemic waning in the U.S. in June, July and the end of summer."
But that will depend on how many people choose to get the vaccine. An October poll by STAT News found that only 58% of the U.S. public said they would get vaccinated as soon as a vaccine was available.
If that is the case, Baric said, half the population will get closer to returning to normal life, and half will continue to get sick and be at risk of hospitalization or death. To reach herd immunity, he said, 70% of the population must be vaccinated or survive infection. Right now, only 5% to 10% of the U.S. population has been exposed to COVID-19, he said.
Making matters worse, he said, is the tumultuous leadership transition since the presidential election.
"It is a real issue, I have to admit. And it has been an issue the whole time," Baric said. "The lack of a single, uniform voice based in public health practices has resulted in a lot of American deaths."
Baric's lab is currently conducting Phase 2 clinical trials for a COVID-19 antiviral drug called EIDD-2801, which is being developed by Merck.
In trials using mice, EIDD-2801 showed that it could prevent and reduce severe lung damage, The N&O previously reported.
And it can be taken as a pill, which makes it easier to treat COVID-19 patients outside of hospitals. Remdesivir, a COVID-19 treatment that President Donald Trump received when he got infected, is taken intravenously.
That means it has to be taken at a hospital. But hospitals are filling up with patients, and it is getting harder to find space for COVID-19 patients.
EIDD-2801 is much easier, he said, but it is unclear when it might be ready for widespread use.
EIDD-2801 could be especially important for rural communities, which have much smaller hospitals. And the current surge in coronavirus cases appears to be hitting rural places harder than urban ones.
"[Rural] hospital facilities aren't as large, and they don't have as much in the way of critical care equipment," Baric said. "And so, sadly, they are approaching that point of no return, where hard decisions may have to be made about who gets critical care and who doesn't. That is tragic for physicians and for families and sad for our country."
This story was produced with financial support from a coalition of partners led by Innovate Raleigh as part of an independent journalism fellowship program. The News & Observer maintains full editorial control of the work.