UM President Frenk:
Give COVID-19 the Seriousness It Deserves
Now dealing with the fourth pandemic of his public health career, Julio Frenk, University of Miami president and acting CEO of UHealth, shares his insight on the lessons we need to heed now — and remember in the future
By Maya Bell
Photography by TJ Lievonen
From left, Dipen Parekh, M.D., chief clinical officer and interim chief operating officer, UHealth;
Tanira Ferreira, M.D., chief medical officer, UHealth;
David Lang, M.D., medical director of the UHealth Tower Emergency Department;
UM President and Acting UHealth CEO Julio Frenk, M.D, M.P.H., Ph.D.;
Emergency Manager Vincent Torres; and
Miller School Dean and Chief Academic Officer Henri R. Ford, M.D., M.H.A.
In April 2009, less than three years after University of Miami President Julio Frenk, M.D., M.P.H., Ph.D., completed his term as Mexico’s minister of health, the country’s disease surveillance system picked up a minor but troubling trend in flu cases. Beginning with one small boy, an odd cluster triggered an investigation that quickly led to the isolation and genetic sequencing of swine flu and a prompt warning to global health authorities about the new H1N1 virus.
Dr. Frenk, who had just become dean of Harvard University’s T.H. Chan School of Public Health, was not surprised that Mexico acted swiftly. A former World Health Organization official who was also involved in the avian flu and SARS epidemics, Dr. Frenk had followed a long line of health ministers who understood the value of robust epidemiological surveillance, rapid and transparent reporting, aggressive control measures and generous sharing of data.
Now, five years after taking the helm at the University of Miami, Dr. Frenk is monitoring COVID-19. After erupting in China in December, the novel coronavirus reached South Florida and forced the University to embrace social distancing and move all classes online. He shares his insight on the lessons we need to heed — and remember in the future.
You’ve now been involved with four pandemics. Did you ever envision the day the world would be at a near standstill, with a tumbling economy and billions of people facing dire consequences beyond their health?
The world has been through this before. These are not new events. The big difference now is, first of all, we’re much better equipped to deal with those outbreaks in a timely fashion, and second, we have many more tools to address them than we have had at any time in the past. What we have is a larger gap because people don’t expect these things to happen, whereas our ancestors were used to life being short and brutish. Today, because we live in societies that have reaped enormous benefits from the investment in science, we don’t expect these sorts of things to happen. And therefore, it is easy to fall into a sort of complacency. But I have to tell you that the experts who look at pandemics have been warning the world that this was not a question of if, but a question of when. That’s why we have been pleading for better tools to be better prepared for this kind of event.
In mid-March, the CDC reported that nearly 40 percent of COVID-19 hospitalizations were people in the 20 to 54 age range. What does that mean for our students?
The message is fundamental: Young people should also follow the directions of social distancing. There are other ways of expressing love and affection for your family members that do not require closeness in proximity. It’s the emotional proximity that matters in this situation. The new data showing that a large population of hospitalizations are happening in younger people should be a wake-up call so that young people also take the measures we are adopting very seriously.
Do the increasing hospitalizations among young adults mean the virus is changing?
No, I do not think that this reflects a mutation in the virus. It reflects that there are more people in that age group than in older populations. The United States has a younger age distribution than European countries, because of immigration. Comparatively, we have a greater proportion of younger people in the U.S. than Italy, Spain, or China. China, with their one-child policy, has sort of skewed the age structure of its population.
Is the scarcity of COVlD-19 tests skewing the reported number of people who have it in the U.S.?
Absolutely. There are a lot of people who have not been diagnosed who are out there because they have no symptoms, and they can be spreading it. That’s why social distancing is so important. What we need to derive comfort from is, if we do social distancing, the number of people infected will go down. We’ve seen the results of that in previous pandemics, and we’re seeing that now in the countries that were first affected, like China. And like Singapore, which introduced very, very severe social distancing measures. So, we see that, irrespective of the amount of tests, if you generalize social distancing measures, you will stem the rise of the epidemic. By the way, it’s not just about flattening the curve so we don’t get so many cases that it will overwhelm the hospitals. It’s also that by doing so, we gain valuable time so that an antiviral drug will become available. That will change the course of the epidemic. The more we can spread the appearance of cases — people who are infected and then develop the disease — the less we will overwhelm the health system, and the more likely we will have enough time to develop tests and deploy new drugs and eventually a vaccine.
What about closing our borders?
The illusion, that if you just keep the rest of the world outside we will be safer, is a very dangerous delusion. It’s quite the opposite. In 2009 the swine flu virus was isolated by a team of Mexican epidemiologists, the leadership of which had been trained in the U.S. The virus was sequenced in Canada. That information became quickly available and there were scientists all over the world working on a vaccine. We quickly developed this global response, which is the only way to deal with these threats. So, we cannot shut ourselves off from the rest of the world. The solution to be better prepared, to detect early and to respond quickly lies in international cooperation, not isolation.
So, if we do what we’re supposed to and COVID-19 wanes and eventually disappears, what are the chances we will be better prepared the next time?
We cannot let our guard down, which has been the systematic failure in all the previous pandemics that I have observed closely. If we now learn that lesson, we will be much better prepared for the next one. Let me give you an example: We have a group here at the University of Miami working on rapid diagnostics for Zika. They were getting substantial funding because, while it was not a pandemic, it was an outbreak affecting a lot of countries and Miami. And, as soon as we got over that outbreak, the funding was reduced. If we keep such funding, we design these platforms that we can then use to develop a specific tool for the next virus. We are actually doing that now for COVID-19, but the funding agencies shouldn’t have lost interest in the platforms after the Zika outbreak.
How much funding do we need?
A minute fraction of 1 percent of what’s been lost in the stock market would be enough to fund a global health security initiative that would make everyone in the world safer. So, the lesson is: we will get through this, just as we’ve gotten through every pandemic. But once we get through it, we would be foolish to assume that this was the last one. There will be another one; and if we let our guard down, we will again incur the same disruption and cost we are suffering now. We owe it to everyone who is undergoing the sacrifices and to all the people who will have died not to relinquish our responsibility, and to keep the necessary investments and the capability around the world up to the level of the challenge. This is a challenge that we can face. We have the tools. It will be faced successfully. I am very confident, thanks to science. But we need to keep those investments. Because it is from the basic sciences that the insights, the innovations, and the discoveries that then lead to the vaccines, the diagnostic tools, and the drugs stem.