When you’re Eric Toner, your life is pandemic planning. He’s sat in front of world leaders, discussing national preparedness and how to cope with mass casualties. He’s ran simulations and looked back to learn lessons about how we collectively responded to SARS and the 1918 flu pandemic. 

Even with all that planning, there was nothing that could have got him ready for how the COVID-19 pandemic is currently running. 

At Johns Hopkins Center for Health Security, Toner spends his days working as a senior scholar and is an international leader in pandemic preparedness. He’s known about the threat of a novel coronavirus for years, only in October 2019 Toner and his team ran a pandemic run-through in New York City. Mere months later, the real thing began to spread around the globe. During the table-top, half-day exercise Toner was in a room with other health professionals to game out a coronavirus outbreak, focussing on the responses from big business and governments, reports Claire Reilly for cnet.

These simulations are nothing new – Johns Hopkins have been running these for years, giving them Hollywood-esque codenames like Clade X – “a biologically-engineers, intentionally-released, airborne pathogen” – and Dark Winter for smallpox. Running these hypothetical responses has been done with the aim to inform experts and policy makers about how best to prepare for a looming pandemic. 

That day has finally come.

Running simulations is, it turns out, nothing like watching how the world actually handles a real pandemic, sweeping indiscriminately across the globe. Toner says that plenty of countries are falling short of what they’d expected.

“The US response has been extraordinarily disappointing and wrongheaded,” he told Reilly via Zoom, at the end of June. “Whenever there’s been an opportunity to do the right thing, we seem to have done the wrong thing. The US has to recognize that it is competing for first or second position of the worst affected country in the world.”

On the back foot

Reilly has chatted with Toner about global pandemics before.

Their first meeting was July 2019; Reilly went to meet him at Johns Hopkins Center for Health Security for a discussion about international pandemic response. It was part of a series called “Hacking the Apocalypse”, looking at how tech could save the world from impending doom. During production, Reilly said it all had a feel of the theoretical about it, something that would be scientifically possible, but could it really happen?

Turns out, yes. Yes, it could. 2020 rolled around and lockdown happened around the world and our vocabulary adopted “social distancing”, “pandemic”, and “quarantine”. Reilly had to rework everything she’d done so far on her documentary – theory had become stark reality. One part of the unmasked, undistanced first interview kept repeating on her mind. 

“Is there a chance that we could be caught off guard by some sort of horrible, mutant bat influenza?” was one of the now-very-pertinent questions I asked, five months before most of us knew what a coronavirus was or where to find Wuhan on a map. .

“Yes,” Toner replied. “And we probably will be.”

Reilly has kept in touch with Toner, chatting often. In April, he wasn’t very optimistic.

“I think one would have to be clueless not to be scared right now,” he told Reilly, over a Zoom call from his home office. “The current coronavirus pandemic is worse than many that we have anticipated in the past … this is going to end up being a truly historically bad event.”

As we enter the second half of a year that’s only been about the virus, the situation isn’t letting up.

Johns Hopkins has been tracking pandemic stats and released an update on July 1, confirming the pandemic had reached nearly every part of the world, with 10 million cases confirmed and over half a million deaths. Out of the 200 countries and territories that have reported cases, there are still 86 that have community transmission, that’s people getting sick from other people in their area rather than importing it from elsewhere, causing local clusters of disease.

In a conversation between Reilly and Toner at the end of June, the feel had changed. The threat is no longer emerging – it’s real and out there. There’s no expectations of quick fixes and ways to put this back in the box. 

Dealing with coronavirus is no longer a sprint, it’s a marathon. 

No let up

There have been many successes on a country level when it comes to fighting coronavirus. Lots of places went into lockdown quickly, listening to the World Health Organization when it said to increase diagnostic testing so outbreaks could be found and contained locally as they came up. 

Now that summer is upon us in the northern hemisphere, any hope of flattening the curve are long gone in the US, with cases rising every day as states reopen during the worst stage of the crisis. Toner plays down the thoughts of a “second wave”.  

“When you’re underwater, it’s really hard to tell how many waves are passing over you,” Toner says. “I don’t know whether it’s a first wave or a second wave. I don’t think it makes any difference. There is a resurgence of cases that, in some states, looks like just a continuation of their outbreaks. In other states, it’ll look more like a second wave.

“I think what’s important is that there’s going to be no summertime lull with a big wave in the fall. It’s clear that we are having a significant resurgence of cases in the summer, and they’ll get bigger. And it’ll keep going until we lock things down again.”

The influenza virus that ran rampant across the world back in 1918, claiming between 50 to 100 million lives globally, was at least seasonal – we have no evidence so far that COVID-19 is. Without a vaccine, the ups and downs of case numbers are going to be based primarily on social elements: community lockdowns, social distancing, shelter in place. And just like back in 1918, people need to be wearing masks.

At least there are some positives that have come out of the first half year of living through a pandemic. Hospitals have figured out how to manage symptoms better and are learning when is the best point in the infection to intervene, bringing the death rate down fast. Toner points to therapies like remdesivir, a treatment that’s had positive effects during trials and has been green-lighted for hospital treatment for COVID-19. Convalescent plasma therapy is also being used with success, transferring immunity from survivors to those still battling. 

Even with these advances, there’s no silver bullet. A vaccine won’t be on the scene for at least twelve more months, and even then getting the immunization rolled out across the globe will take until at least 2022. When that happens, Toner doesn’t rule out the need for a double dose of vaccine for it to work properly.

What’s in store until then? 

“I think that mask wearing and some degree of social distancing, we will be living with – hopefully living with happily – for several years,” he says. 

The time it’s going to take to fix the situation can make many of us feel hopeless. There’s a way to exert some control on our future, similar to the advice Toner has given before during his simulations. The advice is over a century old. 

“It’s actually pretty straightforward. If we cover our faces, and both you and anyone you’re interacting with are wearing a mask, the risk of transmission goes way down. Being outside, having distance between you and other people reduces the risk of transmission dramatically. 

“There are a lot of things you can do and maintain those conditions. If you spread out, if you maintain distance, if you avoid crowded places, you could go to a beach, you go to the mountains, you could go to a lake, you can do things outside without a problem.”

Toner has strong thoughts about people refusing masks

“They will get over it,” he says. “It’s just a question of how many people get sick and die before they get over it.”