On 13 February, Clifford Lane went to a Washington, D.C.–area airport to catch a flight to Japan, where he would help launch a study of an experimental drug, remdesivir, against coronavirus disease 2019 (COVID-19). Lane is a deputy director at the U.S. National Institute of Allergy and Infectious Diseases and a right-hand man to Anthony Fauci, head of NIAID and the top research scientist in the country advising the White House on the outbreak of the virus. As Lane waited to board his plane, he was told that his final destination had changed. “I get an email, ‘You need to go to China.’ It’s like, are you kidding?”
Lane had been selected as one of two U.S. scientists to join a World Health Organization team of 13 international researchers who would tour five different cities with 12 Chinese colleagues to get a firsthand look at the coronavirus epidemic there. The joint mission, which ran from 16–23 February led to a report that offered more details about the clinical course of COVID-19 and the epidemiology in China than had appeared anywhere before.
Lane is a clinician who has been on the front line of HIV/AIDS research and led studies of vaccines and treatments in Liberia during the West African Ebola epidemic in 2014–16. On 4 March, Lane, still under quarantine in his Maryland home, spoke with ScienceInsider about the China trip and his view of the situation in the United States.
This interview has been edited for clarity and length.
Q: What was eye opening to you on the trip?
A: I’d never been to China. I was really surprised with how modern the cities were, and how high technology was in many of the places we visited. The briefing rooms at China’s CDC [Center for Disease Control and Prevention] with these multipanel screens and multiple displays of data was quite impressive. And cities with 15 million people, that’s like, no big deal.
Q: What about the epidemic response itself?
A: There was a completely unified perspective of how this virus was the enemy, and we were launching an attack and we’re going to defeat it. I heard it from the governor of Guangdong province and then we would go to a market, and a community center, and they would be telling us the same thing. And [health officials] were rapidly evolving their approaches. They were on, like, version six of their guidelines for treatment, and that was impressive to me that they were moving that quickly. They were also aggressive in their intensive care, using ECMO [extracorporeal membrane oxygenation, a method that artificially oxygenates blood for a limited period] and people were surviving. If you could maintain someone long enough—I’m just guessing now—for their immune system to grab hold and eliminate the viruses, the people would survive. [According to the Extracorporeal Life Support Organization, 250 facilities in the United States that perform ECMO are on the global registry, but many unregistered centers in the country do have the equipment and occasionally perform it.]
Q: How did the Chinese scientists on the mission and the international team work together?
A: We really didn’t have much interaction until after all the site visits when we got together to put the report together. We would be on one bus, they would be on another bus, we would be on one train car, they would be in a different train car. But they were asking some pretty good questions of the briefers of the different places we went. I don’t think it was deliberate to prevent interaction.
Q: The report has been criticized for not dealing with the human rights issues and not recognizing explicitly that there are few, if any, other countries in the world that could lock down populations and do electronic surveillance of people as China has done. Was it discussed there?
A: It wasn’t discussed directly like that. But certainly, questions would be asked of people who were in quarantine. And the responses would be, “We’re doing our part.”
Q: But it’s China. People cannot speak freely.
A: They’re trying to get things back to more normal and to loosen some of these restrictions. We’d ask, “How much longer could you do this? This has to be really hard.” And it would be like, “Well, we’ll do this as long as we need to.”
Q: Could the United States lockdown Washington, D.C., for this virus?
A: I just don’t know. In most of the provinces, it wasn’t a total shutdown—it was a lot of restrictions, and it wasn’t that the city was shut down and people couldn’t go out. Public gatherings I’m assuming were all terminated, schools were closed. There was a lot of contact tracing, and a lot of isolation of the contacts, and self isolation. And if you look at those epidemiological curves for those provinces, they’re basically close to a few cases a week now.
Q: What did you learn that you think the United States can apply? You mentioned ECMO. Is ECMO something that would be very difficult to do here? How does that compare?
A: Certain U.S. hospitals do it, but we do not have it at the Clinical Center at NIH [National Institutes of Health]. You need a team to do it, you need the machines, and you need to maintain it. It’s one of those things that you either do it in your hospital or you don’t. We don’t do it in our hospital. If we’re going to get a lot of [COVID-19] patients, that’s something probably we should be ready to think about being able to support.
Q: There are some really difficult questions that your team didn’t address. One is what happened at the seafood marketplace in Wuhan, China, that has been tied to the origin of this outbreak? Did you probe that or was it off-limits?
Editor’s note: Chinese state media said more than 1 month ago that the coronavirus was found in “environmental samples” at the market, but no details have been published yet.
A: We definitely asked those questions. That was key. Those first few cases early in December, they’re not all linked to the market. We asked them about the environmental sampling at the market and apparently they sampled sewage. It’s one of the big, big questions, where does this jump from animals to humans occur? What species was it? They clearly are thinking about it, but they don’t have a lot of data on it. I think everyone recognizes that it’s not as clean a picture as you might like. It’s hard to know what you’re not being told.
Q: Do you think this will be and can be contained in the United States?
A: It can be if we do a really, really good job of contact tracing. I’m hopeful that we can. They were able to do a lot in the provinces in China where they had things in place at an earlier point in time. We certainly need to try.
Q: You were quarantined when you came back. Why?
A: I did not feel I was at high risk. However, others who know more than I do felt that I needed to be quarantined.
Q: Scientifically, medically you don’t think it’s warranted?
A: I’m fine going with the program. I’ll say it that way.
Q: Have you even been tested directly for the virus?
Q: If you were to be swabbed right now and tested and tested negative, would there be any reason for you to be quarantined?
A: I don’t think so.
Q: You’re one of the leading health officials in the United States. You certainly could have access to a diagnostic. Why not do it?
A: I work for the federal government, and I’m doing my best to abide by the federal guidelines and what I’ve been asked to do. If I start doing something out of line with what’s being expected of others, that could create some disruption in the system.
Q: How bad is this?
A: Clinically, this is its own virus. It’s not the flu. It’s not SARS [severe acute respiratory syndrome]. It’s something different. It’s a lower respiratory infection in which the typical clinical presentation will be fever, cough, and shortness of breath. It’s more serious than the flu, but perhaps not as contagious as the flu.
Editor’s note: The common cold is an upper respiratory infection, pneumonia is lower, and flu can be both upper and lower.
Q: Do you have any sense from MERS and SARS (two other human coronavirus diseases) whether coronaviruses are easy or difficult to stop with a vaccine?
A: It’s too early to know, but I frequently would ask the question in China, “Do you have examples of people who got infected a second time?” They didn’t. So if you can develop protective immunity and not get infected a second time, then I would hope that we would be able to have a vaccine.
Q: How much longer are you in quarantine?
Q: Are you going stir crazy?
A: It’s OK. I’ve got so much to do. What I miss is interacting with the staff at work because I just can’t do stuff over the phone the way I can do it face to face. Yeah, that’s the hardest part.