The FRONTLINE Interviews

Francis Riedo

Medical Director, Infection Control and Prevention, EvergreenHealth

Dr. Francis Riedo is the Medical Director for Infection Control and Prevention at EvergreenHealth Hospital in Kirkland, Washington. He holds a medical degree from Johns Hopkins and served as an epidemic intelligence service officer at the Centers for Disease Control.

Following are excerpts from an interview conducted by FRONTLINE filmmaker Miles O'Brien on April 9, 2020.

TOP

Francis Riedo

Chapters

Text Interview:

Highlight text to share it

Let’s go to the narrative of February…

So, really it’s January.It’s January 20, the first case.

You’re already attuned to this by the way.

Right, right.

So, you’re thinking about it, right?Is that right?

We are watching and watching with increasing alarmthe events unfolding in China and then Thailand and then other countries around the globe, and wondering when it will become evident that it’s going to emerge.And the CDC had testing criteria out to screen individuals coming back from this increasingly long list — of travelers and anybody in contact.

And those were the criteria.Testing still had to be sent to the Centers for Disease Control.They had rolled out test kits to the 50 states the week before and there was a little snafu in one of the reagents that had to be replaced, delayed testing locally by about a week.But I think when that testing became available, the CDC on the 27th of February added that one additional testing criteria which was to examine or consider testing in individuals who had severe lower respiratory infections including severe pneumonia and acute respiratory distress syndrome.My infection control nurses who monitor these things — I was in clinic Thursday afternoon — they brought it to my attention and just to make sure I didn’t miss it, they sent me an email and they put big red boxes around it.I still tease them about that.

But it was a new, it was a new entree into testing.I contacted Public — Seattle King County, spoke with one of the epidemiologists.They said they would talk about it because you had to get permission to send in tests at that point.And they would talk about it. And Meagan Kay and I — Dr. Kay is an epidemiologist with the Public Health department there —she and I have a relationship going back 10 years... and she contacted me and then we spoke about what the options were and why we were considering this.I went to the critical care unit. Dr. Eric Yim was the pulmonologist, critical care physician, on call that day and we talked about selecting two patients that might qualify under this new testing criteria.

There was a lot of discussion because it entailed having people in negative flow rooms and airborne precautions and putting cappers and poppers and so forth.But I said at some point, we need to look at this.I did give a talk that evening to the hospitalists, just a briefing to sort of bring them up to speed with what was going with coronavirus.And afterwards went up and we settled on two individuals.I’m not sure I can remember exactly why we selected those two individuals other than they were already in rooms that we could just easily flip into negative flow rooms and we tested them the following morning…

So, you — it’s not like you were presented with a case at bedside.You just had, you now, this is something we should just look at, right?

Right.Pick.

Pick two patients.

Of the sickest individuals in the critical unit at that time.And remember, this was flu season.And we’d already had a peak of influenza B in December, and now we were going through the peak of influenza A. And so, the unit was full of individuals with severe respiratory infections.Some of them identified as influenza and some not.So, there was this background of, what else could be going on?

And just to be clear, up to that point, you were limited on testing.The rules required somebody who had traveled to China, correct?

Exactly.Either traveled to one of the, I think at that point, there were three or four countries, or had contact with a sick individual.

So, you see the change in the rules.

Right.

It says, you know, you can — it’s a good idea to test people with –

Start testing.

Start it.

Right, right.

And you said, okay, let’s go down and find a couple of patients.

And I think quite honestly, it was probably start testing because now they had capacity to test locally.So, they weren’t all going to be sent in to Atlanta with all the attendant delays and logistics issues.So, they had local testing capacity.

So, the rules changed, they are now encouraging you to test beyond the initial rules.Because why?

Because I think, there was this realization that there was probably expansion of coronavirus around the world.It just wasn’t evident yet.And we had multiple conversations that day with Public Health — Seattle King County.And ultimately, late that evening, agreed that we would proceed with testing.

I honestly, at that point, had to sort of sell it to the pulmonologist critical care physicians as a training exercise.So, we had to get the right swab. It’s a certain type of swab, certain type of transport media.There’s special paperwork that had to be filled out because we were submitting a specimen to the Public Health lab at the Department of Health, and had to be couriered over.So, all of these various issues had to be resolved and I thought this was as good a time as any to make sure we had all that prepped and ready to go.Friday morning, the 28th, we proceeded with testing.It was really uneventful.We did some nasopharyngeal, oropharyngeal swabs, put them on the transport media.I think I personally brought them down to the microbiology lab. Paperwork was completed and a courier picked them up and brought them over to lab. That was the end of the story.I had a regular day, saw patients in clinic, saw patients in the hospital, was sitting there as I usually do late at night trying to complete my notes and received a call at 7:40 p.m. — I noted the time afterwards — from Dr. Kay at Public Health, and she said both of the tests were positive.

So, you’ve tested two patients randomly.

Randomly.Because of their geographic location in the critical care unit, because they had the capacity to be in negative flow rooms easily, and both were positive.

The only criteria was frankly convenience, in some respects.

We don’t have to move the patients, which you know, were critically-ill patients.You don’t want to move them around.So, they were there.

So, when you do that, and you get two positives, what goes through your mind?

My initial honest response was skepticism.Because, there had been testing problems and this was the, very coincidentally, the very first day that the Public Health lab had been testing.And I thought, the odds of both tests in two randomly selected individuals being positive, with no history of travel, no history of exposure to anybody, was fairly astronomical.And I asked Dr. Kay to make sure that they had been repeated and they were.And asked her were there any negatives that were tested the same day, and she said, there were.So, we went on the assumption that we had two individuals who were positive and I got off the phone.

…When you get two positives, especially when the criteria by which you selected them —

Right.

That is a logical conclusion.This test is not working, right?

Right.There’s something wrong, right?Or — I didn’t think there’s something wrong.I just thought it was improbable.I mean, that thought crossed my mind.I have enough experience with lab work to know that experiments don’t always work, testing doesn’t always work.There are false positives and false negatives.Because these are not simple tests.This is a complicated process.And there had been some reagent problems in the week proceeding this.So, I started — I mean, that was my initial reaction.Because it seems so improbable and so coincidental that we would have two positives on the first two people we tested.

So, when you talked to Dr. Kay?

And you said, this doesn’t sound right.And after all, the CDC test we knew had problems, and you can imagine your skepticism, and then she said they had done separate tests elsewhere that day that were negative?

… So, remember, at this time, they were still testing travelers.So, they had a number people who had traveled, who were being tested and they had a series of negative tests as well as the ones that were positive.They had four positives that day, from what I understand.And one was a traveler coming back from Korea, which at that point was already experiencing an outbreak.And then the fourth individual was the student at the high school that had been picked up and now was confirmed as positive.

So, let’s back up just a little bit. You had obviously have been following the case George Diaz dealt with — sort of the first one.

Correct.

How closely did you track that one?

So, we were aware of it. And coincidentally, Dr. Kay contacted me again on a Friday evening on January 24 and it was about 6:30.I was again in my office doing notes, and she asked for our assistance.They had an individual who had been in the waiting room with that index case,and now was displaying symptoms of shortness of breath, cough, had some underlying asthma and needed to be tested…

So, this is somebody who was beside patient number one at the clinic?

Right, had been exposed.

So, what — was she positive?

She was negative.

Interesting.

Yeah, yeah.So, that test was, we obtained the test, provided some treatment.The test was sent to the Centers for Disease Control in Atlanta and I think we got an answer back four or five days later…

… At that point, it seemed like it was contained, was that the thinking initially?

… It did appear to be contained.There were no additional cases and it sort of went underground.In the meantime, in the background, we’re watching these events unfold with increasing alarm, not only in Wuhan, but in Hubei and then China and now spreading across the globe and wondering when our turn was coming.

You’ve been in this business a long time, you had to think it was here?

I had suspicions that it was here and at a subclinical level.So, the manifestations of this illness are just like the manifestations of all the other respiratory infections we experienced, from trivial asymptomatic — and we’ve seen those.I mean, people that test positive that have just a little bit of a runny noseor a slight cough,all the way to the other extreme of severe pneumonia, acute respiratory distress syndrome requiring intubation ventilation.It was the whole spectrum, but we assumed the transmission early on would be in the younger population, schools, events where there’s a lot of close contact, but it may not have become evident just like influenza until you get into a very a susceptible population and that’s in fact what happened.

All right.So, which brings us back to your two positives…did you run another test to be sure or did you accept that at face value at that point once you talked to Dr. Kay?

Once I spoke with Dr. Kay, we accepted those at face value.I contacted Sandy Kreider who’s the executive director for acute care and nursing services, and contacted Dr. Ettore Palazzo who’s the chief medical officer.

I started both conversations with, “Are you sitting down?” Because this was, I mean, they were aware there was testing going on, but again, this was a huge shift. And incident command was activated that night.Sandy came back in.Together, we went down to the critical care unit, brought half of the staff in, told them what was going on and they went back to work, brought the other half of the critical care unit in, told them what was going on and they went back to work.Now, you have to realize that that staff had been caring for those individuals and they had used standard droplet precautions.So, it wasn’t like they were doing nothing.They were using our standard protocol for individuals with pneumonia and taking those precautions.And so, we then went into... we made a quick decision to test nine additional people that night.

So, we were filling out paperwork to go to the Public Health lab and testing individuals, all nine, and sent those in the following day.Those nine reports came back Saturday, early afternoon/evening, eight of those nine were positive.Right.

Wow.

Right.It was already apparent because of some information that the Public Health department had.Life Care had reported, I believe on Thursday, the 27th as they are required to do, that they had an influenza-like outbreak in their institution. And the criteria for reporting that are if you have two or more individuals with an influenza-like illness, you’re supposed to notify the health department, and it puts into place a number of interventions that help mitigate that sort of thing.

So, they stopped communal dining for example.They stopped social activities.They’re more restricting movements within the facility.And this is very common.I think on that day, Friday is when the Department of Health publishes their flu statistics.If I remember correctly, there were 57 skilled nursing facilities, long-term care facilities that had already reported influenza-like illnesses in their facilities.So, this is pretty standard sort of process and intervention, but the Public Health department had that information and they knew that there was more going on there... and one of early questions was “Are either one of these individuals from Life Care?”And one of them was, but not both, which also told you something, right?Because now we had evidence, and particularly when we had the second day, Saturday, now the 29th, we had additional data from eight more patients that there was a very clear connection to Life Care, but there was also a number of individuals who had no connection.

So, we had evidence of transmission within a health care facility, long-term care facility, and we also had evidence of transmission within the community. And that was telling.We then knew that this was a much bigger outbreak than you could have imagined.

Saturday, you had tested a total of 11 people?

Correct.

And 10 of them were positive.

That’s correct.

That’s unusual mathematics in your world, isn’t it?

That’s correct.Right.

Kind of stunning actually, isn’t it?

It was and within the first five days, we had 32 positives.

Okay.So, at this point, what is your conclusion?

Well, it was very evident that there were at least two chains of transmission.One inside Life Care, which was very obvious.I mean patients were flowing from that facility to ours. And then another one that was outside.There was a brief period when we were concerned about another cluster, if you will, that might be related to dialysis.That did not turn out to be the case.So, there was just another set of community transmission going on and there were ultimately some links that were made to patients at other facilities that were related to our non-Life Care center outbreak.There are also healthcare workers from Life Care that were hospitalized at one of our other hospitals, not our hospitals, but one of the other hospitals in the community here.

So, it was evident that it was not only patients that were being infected, but also the staff at Life Care. And they continued to flow out of that facility as more and more people became ill.

So, it’s much more widespread than anybody guessed at that point?

At that point, it was clear that there were multiple chains of transmission going on in the community that were independent of the chain or the cluster that was associated with Life Care center. And it became evident in very short order that it wasn’t just Life Care, there were other nursing homes, long-term care facilities, skilled nursing facilities, that also had individuals.I think one of the telling messages is that it became evident that these facilities, in many ways, had their own unique epidemiology.

It’s a very closely-contained facility with a highly vulnerable group of individuals who shared a lot of activities; they had communal dining and they also had communal social activities.So, there was a lot of interaction, plus visitors coming in as they would expect, plus staff that was coming in.So, there was a lot of potential for introduction into a closed environment that could then spread quickly.

These facilities are like petri dishes for disease.

I have referred to them as mini-cruise ships and this was — and the analogy I think is apt.You have a crew, you have confined quarters and a lot of social activities as you do, and this was of course on the heels of the Diamond Princess and the cruise ship outbreaks that were going on, and it was clear that they were bigger than we expected.The initial hopes of trying to contain those by just leaving passengers in their staterooms did not pan out.

So, as an epidemiologist, when you are trying to investigate something like this, when it’s this widespread, it’s pretty difficult to trace back all the sources, isn’t it?

That’s correct.Right.And so, we were really reliant on what work we could do in terms of providing history and linkages. And we were able to connect a few dots back to a local car repair facility, and some dynamics of interactions with other family members, to connect a few of those dots and establish chains of transmission. But going backwards would be very difficult.I think the Seattle flu study, which I’m sure you’ve heard about by now, had some of those studies, and I think they may be able to reconstruct transmission in the community going backwards.

One of the things that I regret not doing early on was actually saving all those samples that we did for influenza, and we have respiratory pathogen, multiplex PCRs. And had I thought of it at the time, we could have easily sequestered those specimens and it would have been hundreds of specimens that we could have easily tested and established earliest case and so forth.We did dig into our refrigerators. So we save all specimens for seven days, and there was an individual who one of the hospitalists called me about and said, “You know, I took care of a fellow last week, this was the week before our first case, who was really sick, had a very unusual pneumonia, young man, and we never could figure out what he had.He got better and went home.”And I went down to the micro lab and the microbiology lab and in the bottom of refrigerator was this tub of old specimens that are just waiting to go through their seven-day waiting period and then they’d be discarded.

We found it.It was from bronchoscopy on February 24th, submitted to the Public Health lab and it was also positive.So that was actually our first case.When you trace his story backwards, he was admitted on the 20th of February, had been seen in urgent care twice on the 15th of February and going backwards, again on the 13th of February, and dated his symptom onset to February 9th, which puts his incubation period between January 24th, the same day we tested that individual, and February 7th.That’s the two to 14-day incubation period.So, you could go backwards and see that there was something circulating at a very early time.

Why it's so important to get in there early —

Right.

And a lot of these has to do with what exponential spread is all about.

Right.So, this is a page straight out of all attempts, I think, to identify cases, to figure out what the source is, and then try to mitigate or contain the outbreak.So, you go back to removing the pump handle from the pump where a lot of cases were happening.

But it’s also when you look at the small pox containment process — ultimately came down to finding the last few cases, and doing ring immunizations around those to prevent further transmission. But that also meant you had to identify everybody that possibly had contact with that individual.The same process in Ebola.When I was in West Africa in 2015, 2016, if there was an individual that was identified, you would try to identify all the contacts, place them into quarantine and restrict their motions and ultimately when the vaccine became available, you would do one and two rings of immunizations around those individuals to try and stop the transmission.By the time we tumbled to this, those sort of containment efforts were not possible anymore just because of the sheer numbers.

So, it’s kind of — there’s no point even trying at this point is there?

At this point, it would be very difficult.And even countries that were implementing those sorts of policies successfully, and I would just point out to Singapore, one of my former colleagues is in Singapore and Hong Kong, I think those are two models that worked very hard at identifying every case that came in, identifying every contact of that individual, and sequestering those individuals to prevent further transmission.But even they are, there’s leakage, right?I mean, there’s the people that slipped through the net or are unidentified or have incidental transmission or yet another chain of transmission starts and smolders before it finally comes to attention.It’s not a perfect game.

So, I guess the flu study samples which go back, when did they start taking samples?

I’m not sure when that study started.It’s an interesting—

But that’s a great treasure trove of potential evidence there, right?

It’s huge, right?And I found out two weeks into this whole adventure that my daughter had actually contributed a sample to that flu study.I don’t know what the answer is because it’s all anonymous and restricted access and testing, but I’m hoping that at some point they’ll get to the bottom of it and figure out.See if they can establish when the earliest transmission happened — because it’s quite possible that there was transmission even before the Providence Everett case that Dr. Diaz talked about —it’s possible that there was ongoing transmission from returning travelers going back into January, early January.

Could it, they have gone back even further in time?

Even late December, right?I mean, the Chinese scientists and epidemiologists estimate that it may have been circulating in China as early as late November and became evident.I think they went back in their timeline and established the first case on December 9th.

And then it smoldered along until it became evident and they, I think finally announced that they had an outbreak on December 31st.

So, given how small the world is today, and given the travel patterns particularly between Asia and this part of the world.

Correct.

Would it stand to reason it was probably here pretty soon after it took hold in Wuhan?

I would be surprised if I learn that there were not individuals in the Seattle area, Vancouver, British Columbia area, West Coast in general before the January 20th index case.

You’d be surprise if there weren’t?

If there weren’t, right.I think when they finally get through all the Seattle flu studies specimens, you would find transmission in that group.

All right.Hindsight is 20/20, but as look back on this–

Perfect, right.If I look back on this, I wish I’d saved all the flu tests going back to December.

… You could have had the smoking gun there, right?

We might have found the index case.We would have had to screen hundreds to get there, but we might have found the true index case at least in this area. But there may have been index cases down in California, in Oregon, and even on other states and they burn themselves out before the chains of transmission were well established.

So, you’re the kind of person that follows this.You’re an epidemiologist, you focus on pandemics, there is a certain amount of, well, I guess we’re all caught unaware in some respect, weren’t we?

You could say that.I mean, we were thinking about it here.I mean, again, I have been in practice here since 1991.So, I saw SARS come through and that concern and saw H1N1 come through and then MERS., CoV and then Zika and Chikungunya.And so, this sort of drum beat of RNA viruses that have emerged…So, my entire career has been watching these RNA viruses emerge and causing problems.

And yet they’re still hard to detect?

They’re hard to detect.I think we’re getting better at it.So, again, in the scope of my career, we’ve seen the molecular technology improve…

So, there’s been an awful a lot to talk about testing and botched CDC test and the delays in getting testing deployed.How much would it have changed the story if you had a test at the ready earlier?

I would not call it a botched test.I mean, again, coming from a science lab background, I would tell you that it’s complicated to put this together. And then you’re not moving from just a small one bench, let’s do a few tests, let’s figure this out.Now, you have to create an entire system, a whole collection of tests that are then sent out and the speed with which this happened.I mean, the Chinese identified the outbreak, they then had the virus isolated I believe by January 10th.The sequence was published much to their credit.That’s what allowed the creation of primers.We were fortunate because the Centers for Disease Control did that, but also almost simultaneously, the University of Washington virology lab did that.And I think that’s one of the things that gave Washington State a bit of an edge because we had testing capacity early on to help with these investigations.

… You could make an argument that this area, this region, Seattle was really as ready as any place to deal with this.

We are uniquely poised. And you don’t appreciate it when you’re here because you just assume everybody is like that. But you appreciate the level of expertise that exists within the infectious disease clinical community, the infectious disease academic community, the virologists and so forth.And particularly in the public health sphere here, Dr. Jeff Duchin, Dr. Meagan Kay, both former epidemic intelligence service officers, both with background at CDC, bring to this area I think, and I comfortably say this, probably one of the top five public health departments in the country, closely tied in with the infectious disease community around the city that allows us to have these easy conversations.I mean, I can pick up the phone and speak with either one of them, and that allows us to be comfortable, I think, to ask that question on Thursday, the 27th, should I send some specimens in, who would you like?Just easy.The connections are already made.The relationship is established.The labs exist.

Scott Lindquist said to me the reason it emerged here first is we were looking, we were attuned to it.

Right.Well, it’s that curiosity, right?I wonder.The big question, I wonder if —should we start testing people randomly just go look and start checking out people, and if you did, where would you start?

Have you ever in your career tested a random group of patients like that and gotten that kind of result?

Never. Never.

So, Life Care.Let’s talk about them for a minute.

Sure.

Obviously, you spend a little bit of time looking what happened in that particular place, but as you mentioned, there are other facilities, but Life Care got a lot of attention because of the numbers.

Right.

As best you can tell, did Life Care do anything wrong?

So, let me just preface it by saying that Life Care is a nursing home, a skilled nursing facility within three miles of here.It is a facility that I’ve long had a relationship with.We send patients there that need IV antibiotics.There is a very dedicated staff there, it’s a good facility, and I think you can talk to some of the patients that have been there and there’s a lot of respect.I think it was a well-run facility as a long-term care facility.If you look at what was going on, you’re in the middle of flu season, it’s not unusual to see clusters of illnesses in these facilities because you have visitors coming and going, staff that come and go.Could they have done something better?

Oh sure, in retrospect, it’s very evident you know that maybe they should have called in sooner, but that would then just kick in the measures that you would put into play, right?You stop communal dining, you stop the social activities.

That would have slowed the transmission if you’d identified it earlier because that’s what it does with influenza.But ultimately, I think a fair number of those individuals would still be infected and you can see because there are also chains of transmission going on in other long-term care facilities around.It’s just that Life Care was the first.

So, they were caught unaware just like everybody else?

I think they were caught unaware.I mean, you know, having a collection of highly vulnerable people in one closed facility and then, because families wish to come and visit to see their loved ones, parents and what not, you’re going to introduce things.The world doesn’t shut down just because you’re in a long-term care facility.

Any idea how it got in there?

None, but I mean, it’s you know, it’s a new patient that may have come in.One of the staff that may have come in.One of the visitors that came in.People with families, an asymptomatic child, the child with a little runny nose.I mean, it would be pure speculation to guess.

…You know, you guys your profession is a calling, you take an oath.People who do this don’t do it just because it’s a job, but it has to strike a little bit of fear in your hearts because it becomes more than science, it’s personal.Because you’re bringing something home potentially to your family.

Correct.

What’s it been like dealing with that?

There are some concerns.I think many of the providers here sleep in separate bedrooms and have decreased the contact with their family and their children and that has been very hard.My children are grown but even for us, the concern is there.But I can imagine how difficult it is for families with smaller children where you really need that contact.

And also, we’ve seen, you know, some of our colleagues become ill.It’s very difficult but—and I say this generously but we have a phenomenal staff and I — the hospitalist team, the pulmonary critical care physicians, the emergency room physicians, my colleagues, the infectious disease team — nobody has stepped back and said, “I’m not willing.”I’ll exemplify it.One morning we were down in incident command and received a call from Life Care that they have eight patients that they needed to transfer for evaluation.They had lost the capacity to do x-ray studies or to do lab studies in-house.So, they were flying on clinical exam symptoms and these individuals needed further evaluation.Eight at one time.So, I walked across the hall into the emergency room, found Dr. Hanson.Kevin Hanson is the director of the emergency room and went up to him and he said, “Life Care needs to send eight people” and I thought, you know, he would say, “Well, let’s work this out maybe we can send someone in.”He said, “Send them in.”Not a hesitation and that has been from the start, the way we have operated here.You talk about soldiers running into fire; that’s what the physicians here did, the nurses here did and it’s more than that.It’s the environmental service people who are going into these rooms and cleaning up.Security, radiology, lab people.I mean, it’s everybody.It’s a remarkable effort.Public Health, who was trying to help.

You know, hero is an overused term in our society.

It really is, right.

But it does seem to apply here, doesn’t it?

I hesitate to use that term because it’s what we’re trained to do.I mean, I think, what else would I do?If not me, who, right?If not us, then who?And so, the duty becomes to provide the care and to provide the safety to the caregivers that you can make happen.

But it is scary?

I think all of us have had pauses.I think those pauses come when you see your colleagues infected and, you know, early on, two of the Chinese physicians that are infected passed away and there had been enumerable health workers infected here, in Italy, and around the globe.And they have stood up oftentimes with little or no PPE to take care of patients.

… So, what’s it like treating these patients?You’ve treated a lot of people with these sorts of disease in the past.Is this one different and what are the particular challenges?

I think the big challenge is trying to figure out who actually has it?The testing is not perfect.We’ve learned that sometimes you have to do two, three tests.We also have learned that it depends on how you take the test.So, how deep you go into the nasopharynx and how long you’re in there makes a difference if you get an adequate sample.And the spectrum of illness is really amazing.However, it’s not really much different than the spectrum of illness that you see with influenza.Many patients, I think have influenza with mild or trivial symptoms all the way to those individuals that end up in the critical care unit and are intubated.It’s just that this is novel, it’s new, there’s no previous existing immunity, there’s no vaccine.So, everybody is starting from the same point.Unlike influenza where there have been years of circulating virus and an annual immunization that you can take advantage of to slow the spread or to ameliorate the symptoms.This is totally new.

So, you don’t have a therapy that’s proven out.

Right.

There are some antivirals out there that people have tried.There’s some anecdotal stuff out there.What are your thoughts on — what have you been using?What have you been trying?It’s kind of like running an experiment in real-time.What’s that been like?How have you been approaching that whole thing?

Yeah so, again, coming out of the Ebola era when I was very sort of discouraged by the lack of effective therapy that came out of Ebola.In many of the studies that were done were conclusive only long after the fact.These medications that were touted as showing promise, ultimately, showed to be of little or no benefit.

And I saw ourselves going down that same pathway.A lot of hype and enthusiasm for all these different things and you can top the list with hydroxychloroquine, chloroquine, the antivirals, Remdesivir, the immunomodulators like tocilizumab and others, high-dose vitamin C, zinc.Everything thrown out there.Again, with very little data to support it.And my fear was that we’re going to end up on the same spot in 18 months, in 24 months with nothing to show benefit, just a lot of anecdotal stories.And in fact, much of the early data coming out is along those lines.Uncontrolled trials of small series of patients not randomized, not controlled with data that are very difficult to interpret or generalize.

So, I think putting some science into this and having some well-controlled studies was critical.

… So, when we hear these stories like the patient number one story, he gets Remdesivir and is out the door pretty much 24 hours later.That’s just a story, right?

Right, it’s an anecdote and there’s a saying that the plural of anecdote is not anecdotes and it’s not data.It is not a study that you can generalize.It’s wonderful that it happened, but it’s as likely with one patient that it happened by coincidence.I think you should take something from that and then carefully control it, make sure before you subject a lot of people to an agent that may be of no benefit.And it’s not that it may be harmful, but you also may be wasting your time giving somebody something that doesn’t work when something else that’s more promising should be studied and investigated.

… So, when someone says, “What’s the harm in doing it?”What is the harm?

Well, the harm is twofold.One is there is potentially a side effect of a medication, right?There’s always reactions and side effects that are unpredictable until you get a large number of patients. And sometimes for example, some of the antibiotics that have been released, it wasn’t evident that there were problems with liver toxicity until you had 5,000 patients and then it became very evident.The point of using a medication that you think might be beneficial based on limited or poor-quality data will then sometimes give you the sense that you’re doing something when in fact you’re not, and precluding the use of another agent. And we’re already encountering that.

It’s very difficult to enroll anybody in a trial because they’re all insisting that they get hydroxychloroquine.So now you’re going to have data that are going to be much more difficult to interpret because of this confounding variable.

So, there is harm in getting out ahead of the science?

I think there clearly is, and we repeat the same mistake over and over and over again. And I would just ask people to step back and if they have the opportunity to either develop a study or participate in the study that’s well-designed and gives us some answers going forward.And it may be that Remdesivir is going to be great, and it may be that Remdesivir is not going to work.But you won't know until you do the study.

… These studies don’t happen overnight.

They don’t.

People are impatient and we’re in the middle of a pandemic.

Right.Right.

What do you say to them?

You have to take your time and do it correctly or we’ll be repeating the same scenario for the next coronavirus which will come or avian influenza which will come at some point or the next RNA virus that emerges out of the zoonotic world as we interface with that, and that will come also.

Latest Interviews

Get our Newsletter

Stay Connected

Jon and Jo Ann Hagler on behalf of the Jon L. Hagler Foundation

Koo and Patricia Yuen

Funding for FRONTLINE is provided through the support of PBS viewers and by the Corporation for Public Broadcasting. Additional funding is provided by the Abrams Foundation; Park Foundation; the John D. and Catherine T. MacArthur Foundation; and the FRONTLINE Journalism Fund with major support from Jon and Jo Ann Hagler on behalf of the Jon L. Hagler Foundation, and additional support from Koo and Patricia Yuen. FRONTLINE is a registered trademark of WGBH Educational Foundation. Web Site Copyright ©1995-2025 WGBH Educational Foundation. PBS is a 501(c)(3) not-for-profit organization.