NPR’s Noel King talks to Dr. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, about how the coronavirus spreads.
NOEL KING, HOST:
In China, the death toll from the coronavirus has hit 2,000. World leaders and public health officials are trying to contain it, but new infections keep showing up – Carl Goldman, for example. He was a passenger on the Diamond Princess. That’s the cruise ship where hundreds of people got the virus.
CARL GOLDMAN: We took an exotic cruise to Southeast Asia for my wife’s birthday and Christmas present. Who knew we were going to end the cruise in beautiful Omaha?
KING: Here’s how he ended up in Omaha. Carl and his wife Jeri were quarantined on that ship for 12 days, and they felt fine the whole time. But then they got on a flight back to the U.S. and Carl started feeling sick.
GOLDMAN: When we were flying back from Japan to the states, about two hours into the flight, I woke up with a high fever after napping a little bit, and the doctors onboard confirmed it.
KING: And then when the flight landed, he tested positive for the coronavirus. He’s recovering now in a biocontainment unit at the University of Nebraska’s Medical Center. He’s going to have to spend 14 days there in isolation.
GOLDMAN: Right now, they’re giving me a lot of Gatorade, believe it or not. I’ve only been here two days so far, but different doctors seen me each day, dressed in hazmat outfits. I’ve got a little cough still. You can hear my voice is a bit raspy, and I’m a little fatigued. But that may be also because of the jetlag and the travels and everything else on top of it. So, no, it doesn’t feel any different than, you know, recuperating from a regular cold.
KING: Carl’s wife, Jeri, hasn’t been diagnosed with the virus, so she’s being monitored in a different part of the hospital. But their case is a good example of some things we know and some things we don’t know about how this virus is spreading. So we have called Dr. Anthony Fauci. He’s director of the National Institute of Allergy and Infectious Diseases. Good morning, sir.
ANTHONY FAUCI: Good morning.
KING: So Carl Goldman was fine all those days on the ship. Then he gets on a plane, and he gets a fever. What does that tell us about how this virus is spreading?
FAUCI: Well, the virus has the ability to bind to certain cells in your body, particularly in your lung. So you can get anything from mild asymptomatic illness to a cough and a fever. To some people, about, oh, 20% of the people who come to the attention of medical physicians and health care providers, can get serious pneumonias requiring intensive care. It sounds like this individual is on the mild side of the illness because, as he said, it doesn’t feel much more than just a common cold. And as a matter of fact, coronaviruses in general, prior to this, are one of the causes of the common cold.
KING: OK. So what does that tell us? I mean, we’re often looking at the cases – we’re looking at a rising death toll, which is tragic. We look much less at the people like Carl who say, you know, my voice is raspy. I had a fever. I had a cough. There’s a wide range of symptoms with this virus. Do we know why some people seem to be doing OK and other people are getting hit really hard?
FAUCI: Well, there a couple things about that. For the first thing is that in any kind of viral infection or any pathogen infection, there’s always a wide range of responses in the sense – almost like a bell-shaped curve. Some people get no symptoms at all. And we do have asymptomatic coronavirus infection with this particular episode. And then there’s the bulk of people who get some sort of symptoms. And then a smaller percentage of people do really, really very poorly. Now, that relates to the ability of the body to handle the virus. And the one thing we know – and it’s not unique to this virus – is that the elderly, those with underlying conditions like chronic heart disease, lung disease, diabetes, obesity, they tend to get more complications, much more than, for example, an otherwise healthy individual. And that’s the reason why if you look at the death rate, which is around 2% for this disease at this time, it is disproportionately higher among the elderly and particularly those who have underlying conditions.
KING: Then there’s this interesting question. Carl and his wife, Jeri, presumably, they were together the entire time they were quarantined, right? He gets the virus; she does not. Did she just get lucky? Do some people have some sort of immuno defense that others don’t?
FAUCI: It’s a combination. That’s a good question. It’s a combination of both. There is no virus that has 100% attack rate. Even the most infectious of all viruses, like measles, doesn’t get 100% of vulnerable people. But respiratory viruses, particularly things like influenza or the coronavirus, the attack rate is varying percentage. And it was really likely that his wife – I don’t think she necessarily had any underlying immune protection – though, that’s possible. There may be some cross reaction of immune protection with other microbes that she came into contact with. But it most likely is, as you suggest, the luck of the draw.
KING: OK. Interesting. And then, Dr. Fauci, I wondered if you could clear something up because we’ve been hearing reports about so-called super spreaders. These are people who spread the virus to a very high number of other people. And it sounds like a scary thing. But I just wonder, is this a real phenomenon that there are people who give the virus to more people than most? And why is that happening?
FAUCI: Well, certainly the phenomenon of a super spreader is real. We saw it with SARS back in 2002 and 2003. And there are episodes already with this particular new coronavirus. And it’s a combination of two things. It’s an individual who’s either at a particular moment in time shedding a very large amount of virus, which makes it much easier to infect a group of people who are around him. But you also see it sometimes in the hospital setting when you have a number of health care providers taking care of someone and that person is shedding a lot of virus. So the short answer to your question is there are super spreaders and it’s a real phenomenon.
KING: OK. OK. What would you say, at this moment, is the most important or the most pressing question about this virus that we don’t have answers to yet?
FAUCI: Well, what we don’t know for sure – we know that there are people who are infected who are without symptoms or very minimal symptoms. They hardly notice they’re infected. What we don’t know is the extent to which people who have no symptoms are spreading it. We do know that this can occur because we have anecdotal documented cases of people who do not have symptoms who actually have infected someone, usually a family member. But we don’t know the extent to which this occurs in the broad component of this outbreak.
KING: Dr. Anthony Fauci, the director of the National Institute of Allergy and Infectious Diseases. Sir, thanks for joining us.
FAUCI: It was a pleasure to be with you.
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