COVID-19 Outlook: An Interview with George Rutherford

Tell me about your role with COVID-19 responses—what do your days look like?

It’s been non-stop 20-hour days since February. This is one of the great public health challenges of our time. I do everything from large research projects, to providing direct services—my group at UCSF is doing most of the contact tracing training for California—to providing hands-on technical assistance in Alameda, San Mateo, and Imperial counties. I also advise the San Francisco Department of Public Health on surveillance and testing strategies, and coordinate research activities between them and UCSF. I also do a lot of the press and Grand Rounds and town halls. And I have students.

Sounds overwhelming.

Yeah, talk to my wife about it. I deal with everyone from the city, to the state, to the federal government, to Congress and the Trump administration, to the World Health Organization. I also provide advice to other countries—New Zealand, Mexico, Jamaica, Trinidad, and Peru.

When this hit around February, did you and your peers expect that it was going to be a world-changing event?

We did not originally think that it would be life changing. By the first week of March, we understood that asymptomatic community transmission was occuring. That’s when everybody realized that this was going to be much bigger deal than SARS and MERS, which were mostly spread in hospitals.

A piece in the New York Times cites a model that predicts that, under current policies, the U.S. is on track to have 150,000 new cases a day later this year. How worried should we be?

We should be very worried. We’re averaging 50,000 cases a day and 1,000 deaths a day [at the time of this interview], and it could get worse. We had a first wave, which was New York. It was initially suppressed in California, but then we got a much bigger second wave courtesy of the South and Southwest.

The issue of school re-openings is very concerning. Leaving the state of the nation in the hands of 12 to 22 year olds is not good policy. You saw what happened with the schools in Georgia, or in Chapel Hill, North Carolina, where they took no precautions and managed to stay open for five days. You should have seen the headlines. It’s like the gang that can’t shoot straight. It’s really troubling. Governor Newsom is being appropriately prudent in keeping a lid on schools.

We should also be worried about farm workers. That’s where all the disease is now. And there are limits to what you can do. You need crops, and they all have to live together unless you put them in sleeping bags on the ground, or put them up in motels, and there aren’t enough motels in the whole Central Valley.

How prepared was California for something like this?

We were very prepared. There were a lot of contingency plans—for example, the six Bay Area Health County Health officers put plans into place on March 16—the day before Saint Patrick’s Day. That was no coincidence. The rest of the state went down on March 19. We did as good a job as we could early on. There’s a lot of pressure to reopen—on the Governor, on the boards of education, on local health officers.

One of the things that nobody talks about is the border with Mexico, which reopened and a lot of people came into Imperial County. A lot of them were Americans who were retired in Mexico. And that seeded Imperial County. We had Imperial Country patients here at UCSF, they were at Stanford, at San Francisco General Hospital. They had them at UC Davis. That’s a big deal.

That outbreak probably seeded the Coachella Valley, which seeded the Central Valley, and so on, all the way up into Redding. Then somebody who was not being particularly thoughtful sent 122 prisoners from Chino to San Quentin, the oldest prison in the state. Seventy percent of the prisoners are now infected. When those big institutional outbreaks happen they spread widely. Right now we’re seeing factory outbreaks in places like meat packing plants, fruit packing plants, and manufacturing plants.

Some experts have suggested that if we have an aggressive lockdown for six weeks or so, we can get control of this thing. In your conversations with decision-makers, what prevents more aggressive measures? Or is it not that simple and wouldn’t work anyway?

It probably wouldn’t work. First of all, all the fruit and food would rot in the fields. That’s a problem, right? And you’d have to enforce it and probably arrest a lot of people. The time for tight lockdown was early on. We did a half-assed job of it. But it’s what society will tolerate. You don’t want a rebellion, you don’t want widespread lawlessness. You want to be able to pull it off as best you can, and I think we did that well early on. Then in mid-June people said, enough is enough. That’s when the controls came off.

You’ve worked extensively on HIV/AIDS. How similar or dissimilar is the government and the public response to COVID-19?

It’s similar in that there was a lot of press attention, a lot of public attention, and a lot of local government attention focused on it. You see that with COVID-19, too. What’s also similar is that most of the federal government stayed completely out of it, except the National Institutes of Health. I don’t know if you remember this, but Reagan never said the word “AIDS.”

What’s different—the Centers for Disease Control and Prevention (CDC) exhibited great leadership during the HIV/AIDS crisis, which they are not doing now. And during the early days of HIV/AIDS, there was a lot of altruism—the formation of social services, which became known as the San Francisco model, that provided support to communities, from health and education, to food and social services and housing. That felt coordinated compared to this.

What about this pandemic has surprised you?

What surprises me is the complete abrogation of federal responsibility.  Public health is admittedly not addressed in the Constitution—it’s not mentioned in the Bill of Rights. The 10th Amendment says that unless the issue is covered in the previous nine amendments, it belongs to the states. That’s why the states have public health laws. But this is something that needs really clear central leadership. The states look to the CDC to lead with planning, policy, and recommendations, and to Congress and the administration to provide the funding and regulatory infranstructure to bring essential products (test kits, drugs, vaccines, etc.) to market.

Do you think that the heightened nationalist global environment is impacting the global response to COVID-19?

I don’t see a lot of evidence of that outside the United States. The vaccine that’s farthest along is a Canadian-Chinese vaccine. There are a lot of joint ventures and a lot of transnational cooperation. But not in the U.S. The one international vaccine trial we cooperate with is the AstraZeneca vaccine being made in Britain, but nobody is thinking big picture. How are we going to distribute one hundred million doses? What about Canada or Mexico—our largest trading partners? What are we going to do to help them? The attitude of this administration is that it’s their problem. It’s very xenophobic and narrow, and the administration is hugely at fault for that.

What about the state of the country makes you feel encouraged, and what worries you?

The least encouraging thing is that the Chinese gave the U.S. a two-month lead time to get our ducks in a row, and the U.S. didn’t do it. The CDC thought this was going to be like other manageable infectious diseases, and wanted to control all the testing. So rather than having a million test kits available in two months’ time, we had hundreds available. The fact that the Food and Drug Administration wanted to close the CDC’s laboratory because they weren’t following good laboratory standards is very telling. With testing highly restricted, we didn’t know what was going on. I see that as one of the biggest failures.

What’s encouraging was that the central Chinese CDC got to Wuhan on December 31, had the virus isolated on January 7, and fully sequenced on January 10, and had a diagnostic test for the virus by January 14. I find that speed for molecular biology totally remarkable. That’s the most encouraging thing. And the lessons spread rapidly around the world thanks to international health regulations and their attendant treaty obligations, which were put into place by the World Health Organization (WHO) in the wake of the SARS epidemic of 2002-2003. This is probably the fifth time WHO has declared an outbreak a Public Health Emergency of International Concern (one of the core activities in the International Health Regulations). The others were for Ebola virus (twice), swine flu (2009) and Zika virus (2016).