A realistic timeline for the development of a COVID-19 treatment and vaccine, long-term social distancing options, and the plight of small businesses, hourly workers and vulnerable children were some of the topics covered in the University of Pennsylvania Leonard Davis Institute’s first “Experts at Home” virtual seminar.

Titled “So You’ve Socially Distanced, Now What?,” the March 27 virtual gathering brought together six top experts to discuss the latest COVID-19-related developments, projections and scientific quandaries. Occurring over an online Bluejeans video network, the seminar enabled LDI to continue its half-century service as a hub of health services research facilitating the interdisciplinary interaction and collaboration of its more than 400 Senior and Associate Fellows.

First in a new series

“One of the core functions of LDI has long been to bring people together in seminars and conferences to talk about important health policy and research topics,” said LDI Executive Director Rachel Werner as she opened the seminar. “We’re now living in unprecedented times that prevent us from physically gathering together. Nonetheless we wanted to continue this important work. This seminar is the first of a series of virtual events we will be organizing over the coming months that will cover topics including COVID-19 and the anticipated aftermath of this pandemic in terms of health, health care delivery and the economy.”

The seven participants were host David Grande, MD, LDI Director of Policy; Susan Ellenberg, PhD, Penn Professor of Biostatistics; Alison Buttenheim, PhD, MBA, Associate Professor of Family and Community Health at the School of Nursing, and Health Policy at the Perelman School of Medicine; Michael Levy, PhD, Associate Professor of Epidemiology at the Perelman School of Medicine; and Richard Prisinzano, PhD, Director of Policy Analysis at the Wharton Budget Model. Moderating the event was Dan Gorenstein, Executive Producer and Host of Penn’s Tradeoffs podcast that analyzes health care trends policy.

Quest for a treatment and vaccine

One of the high-interest points for speakers, as well as audience members who submitted questions, was the status of development efforts for both an effective treatment for the infection and a vaccine to protect against it.

While the panel’s scientists concurred that both measures were crucial in the fight against the virus now spreading at a rapid pace across the U.S., they cautioned the public to keep expectations in check.

“There are lots of treatments being evaluated right now,” explained Susan Ellenberg.”The World Health Organization is just about to start a large, multi-arm global trial of a number of different products. In recent days, we’ve heard about trials of convalescent plasma being started (plasma from people who have survived the infection and built up antibodies against it). Answers from one of the first trials with the antiviral Remdesivir in China are expected sometime in April. I would think that in the next six or seven months, we’ll have answers on a number of these agents.”

‘Only if we’re lucky’

She noted that vaccine development takes longer, often much longer. “We started looking for a vaccine against HIV 30 some years ago when I was in the National Institute of Allergy and Infectious Disease (NIAID), and we still don’t have one. The numbers 12-to-18 months have been tossed around in relation to development of a COVID-19 vaccine, but that’s only if we’re lucky and the very first vaccine candidates that go into study turn out to be really effective.”

In the interim — from now until effective treatment and vaccine are developed — the country’s main tool will continue to be social distancing; but the cost of that is a dramatic turndown of the U.S. economy that is itself fueling political and stock market trauma. None of the participants favored easing social distancing restrictions even though some top federal government officials have continuously discussed the need for that.

“The tradeoffs to opening the economy back up are more deaths versus less of a recession,” said Wharton’s Richard Prisinzano. “It doesn’t seem prudent to me to open up now. But if there was information that said we have slowed the spread of the virus and people aren’t getting infected and we have a real treatment for those who do, then I would say OK, let’s think about opening back up.”

Turning social distancing on and off?

Because a number of national health care authorities have predicted that the U.S. COVID-19 epidemic will expand and wane in multiple “waves” over time, the panel discussed how social distancing policies could be adjusted for that over an extended period of time.

“You can imagine a situation where you can’t have more than 10 people in a store of a certain size,” said Prisinzano. “This kind of thing could potentially keep some businesses open. We’ve all seen the signs ‘By order of the Fire Marshall, only 200 people in this room’. That number would just all of a sudden get divided by ten, which might give some easing on business but still keep the social distancing operating.”

Alison Buttenheim didn’t believe trying to turn social distancing on and off repeatedly would work. “Think about how we might build a policy around that,” she said. “That would be really hard to implement if you’re a school district or a university or a community with a lot of small businesses in it. Just like we need creative solutions for protecting vulnerable populations, we’re REALLY going to need some creative solutions to partial, repeated cycles of clamping down and easing up on social distancing restrictions.”

Segment low and high risk?

David Grande pointed out that one theme in the current political debate around COVID-19 proposes that social distancing restrictions be lifted on low-risk people while even tighter restrictions are placed on people at high-risk for the disease.

“I don’t think that’s a good idea,” said epidemiologist Michael Levy. “Low risk people are connected to higher risk people and even suggesting this is not super helpful. What we will have is a lot of people becoming infected whether we want to or not.”