Matthew Bonds: COVID-19 – What’s Next?

Infectious disease specialist Matthew Bonds shares the science behind diseases, pandemics, how they spread, and how they are contained. Having spent time studying and working to improve health care delivery systems in countries such as Rwanda and Madagascar, Matthew brings a unique perspective to this conversation on the pandemic reshaping every aspect of modern life.

“Science is moving faster than I’ve ever seen it in my life.”

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Matthew Bonds:

I was kind of a recovering academic. I didn’t like the role, the way that the academic work that I did seemed detached, or delayed, or indirect in how I was helping folks. I didn’t believe that my colleagues, who do mostly academic work, were helping people. I didn’t even think they understood the systems that they were evaluating, right? I don’t think development economists understand poverty, frankly, and that concerned me. I was worried about my … That’s my own sense of integrity.

Manisha Thakor:

Hello. I’m Manisha Thakor, and welcome to season two of true WELLth. When you heard today’s guest express his concern about whether or not development economists truly have a boots on the ground understanding of third-world poverty, or whether that knowledge was in more of a detached, delayed, or indirect connection to solving real-world problems, you were hearing from a real-world expert in this area. Our guest today is Matthew Bonds.

Manisha Thakor:

Matthew has doctorates in economics and infectious disease ecology. He used his mathematical models of ecological systems to understand the dynamics of poverty and disease. He is also a co-founder and scientific director at PIVOT, a healthcare delivery organization in Madagascar. He is currently on the faculty of the Department of Global Health and Social Medicine at Harvard Medical School. Prior to this, he lived and worked with Partners in Health in Rwanda for five years, and did his postdoc at Columbia University’s Earth Institute.

Manisha Thakor:

As I speak right now, it’s in the middle of May 2020, and we are either still in the middle or hopefully finally nearing the end of a global coronavirus pandemic that has united the world in a way that has been truly unprecedented. While many of us are starting to become fatigued by daily discussions about the virus, this is a great time to remind ourselves of the silver lining this pandemic may ultimately produce, mainly a triggering of discussions across a wide range of disciplines about the new ways in which humans could interact with each other for enhancing the greater good.

Manisha Thakor:

Enhancing the greater good is exactly what Matt, with his PhDs in economics and infectious disease ecology, is striving to do in the arena of healthcare delivery, particularly in the areas of the world that are no stranger to the ravages of disease and suboptimal healthcare delivery systems. My conversation with Matthew was wide ranging and ends with a powerful commentary of hope. So, buckle up as we walk through some of the scientific community’s initial big-picture takeaways from COVID-19. We’ll start by asking Matthew a question many of us never expected to be asking when we were toasting the start of a new decade back on New Year’s Eve 2019. So Matt, let’s start at the very beginning. What are infectious diseases and pandemics, and why should we care?

Matthew Bonds:

Sure. Infectious diseases are other organisms that harm us. That’s their definition, and they are microorganisms, or at least very small ones. They take the form of a pretty big range. They could be viruses, or bacterial infections, or parasites. The only difference between the normal language of an infectious disease and a pandemic is that pandemics are new and they go global. So, we have infectious diseases all the time. We transmit them from person to person. They become endemic, and every once in a while a new one arises that we have to deal with. If it spreads over a large enough portion of the globe, it becomes considered a pandemic.

Manisha Thakor:

Given we’re in the context of coronavirus, we’ve been hearing a lot on the news about pandemics in the modern context. How does this COVID-19 outbreak compare to pandemics that might have happened, say 100 or 200 years ago?

Matthew Bonds:

Yeah. I mean, diseases have always been with us. They’ve always been with every other organism. Infectious diseases, they’re part of the natural ecology of human beings. What makes a pandemic happen is that something emerges and it’s able to spread. So, there have been some, unfortunately, large famous pandemics such as the bubonic plague in the middle ages, smallpox coming from introductions into the new world. The only real difference now is, one, we know a lot more about them, and where they come from, and we can actually pinpoint their sources, and just the world is a lot more connected. It changes a lot quicker.

Matthew Bonds:

So, you have diseases. If the disease is in one small population, that population can enter other populations, that is like other countries, and the ability to spread is faster. Diseases like Ebola have been around for a long time. Coronaviruses have been in bats for a really long time. It’s just now they have increasing opportunities to skip from one species to another, and then sometimes multiple species before they connect with humans. Then they have a lot of opportunities, way more than they’ve ever had, to spread across the world so quickly.

Manisha Thakor:

Matt, scientifically how do you describe what coronavirus actually is?

Matthew Bonds:

That’s a really good question. Coronavirus, it is an RNA virus that has been around for maybe even millions of years in bats. As far as we know, it doesn’t cause harm in bats, and there are lots of other species of coronaviruses. There are coronaviruses that cause the common cold. There are often associated respiratory infections, and then there have been a few large deadly coronavirus outbreaks such as the SARS that happened around 2001, and then MERS. This is just another form of a closely-related coronavirus that for reasons that I don’t think we know very well now have been able to be more fatal in some, like the common cold. But in particular, it’s not that it’s more fatal than the SARS virus that was earlier in the century, but it’s a little bit sneakier, this one. It’s been very infectious before symptoms emerge and it’s been harder to contain.

Manisha Thakor:

Now, you mentioned that pandemics are not new in the history of mankind. How does COVID-19 compare and contrast to previous pandemics the world has faced?

Matthew Bonds:

Yeah. I mean, the big comparison that scholars like to cite right now is the 1918 flu, which killed on the order of a couple hundred million people. That would be unlikely now, but particularly because of our ability to manage it. The science has changed a lot. I mean, we didn’t have the signals that came as early as you would have liked, but we did have quite a lot of early signals, and people were aware of COVID-19 as early as December out of Wuhan, and alarm bells were rung.

Matthew Bonds:

It just took us a while to realize how fast it was really going to move, but infectious disease modelers, or the kind that I work with, are saying, “Hey. This has the basic characteristics of a pandemic. This transmits really fast. It’s novel, so we don’t have an immune response to it. We don’t have any vaccines, so it’s going to continue to spread in the rest of the world the way it’s been spreading in Wuhan. If we don’t stop that, then it’s going to get all over the world.” Because of these signals and because of the ability to collect data and to communicate really quickly, we are able to shut things down before they get worse. We’re not waiting for everyone to suffer without basic information.

Matthew Bonds:

One of the big lessons right now, I’d say is just our ability to stop. One big difference as well is our science is a lot better, and so data that was collected in ’19 on the probability of dying when you’re infected is just not as reliable as it is today. They don’t have the same kind of representative surveys of the population that will ultimately allow us to know exactly the properties of COVID-19, but it’s starting to look a lot like a 1918-type flu. That was kind of hard to believe at the beginning of this pandemic, but to me it seems clear as the data come in, and as we see situations like what’s going on in New York where 20,000 people have died, and that’s post-lockdown. It’s becoming clearer that this is quite a deadly disease that would definitely take a lot of lives without these policies.

Manisha Thakor:

Let’s switch gears and talk about learnings from this crisis. What has COVID-19 shined a global light on with regards to healthcare delivery systems, which is a big focus of your work?

Matthew Bonds:

Oh my God. The core work that I do is in global health, and that global health is around implementing global health systems, and it’s around the framework of rights to healthcare. So, the way that I tend to look at things is if it’s possible to prevent unnecessary lives lost, then we should do that, and especially if it’s very feasible. We see that. In developing countries, we see that a lot with very preventable and treatable illnesses. Of course, when I say preventable and treatable illnesses, I mean usually in the developing world infectious diseases, diseases that if one person isn’t treated another person can get. So, there’s a very strong, just from a pure efficiency argument, a self-serving argument in light of self-interest, we have a really strong interest in other people’s health.

Matthew Bonds:

We don’t normally have the same … In the US, we suffer from much higher rates of noncommunicable diseases. That’s true for us. That’s true in a lot of middle and upper-income countries. We, for those who have physical space and have clean water, don’t feel particularly threatened by other people’s health condition. We might care on an ethical level, but we don’t feel usually directly threatened. But now is a pretty clear situation where we have a health system where we really do need everyone to know their serostatus, whether they have been infected, whether they have antibodies. We have a very particular interest in everyone doing that.

Matthew Bonds:

We haven’t had a health system that was well set up for that, and so a lot of people, we are seeing it already of course, groups of color are having higher rates of fatality in New York. Lower income socio-demographic groups are being more affected, but we have just a very selfish interest in that. I think we’re also just witnessing the breakdown of the entire health system in many respects in terms of just these fundamental flaws, and the concept that people who are sick might not actually be able to get care. I think as a fundamental concept of how our health system works, I think that is more exposed now than it’s ever been.

Manisha Thakor:

I’m reminded of Helen Keller who famously said, “Alone we can do so little. Together, we can do so much.” How much collaboration is or isn’t going on amongst the global infectious disease’s scientific community?

Matthew Bonds:

Yeah. It’s really fascinating. On the science side, there’s more collaboration than there’s ever been for anything ever. It’s really amazing. I mean, I think in general, to be honest, scientists are really collaborative. Just intellectually, scientists benefit from working with other scientists, and as a matter of necessity big science moves forward with many different components from sometimes there are technical or engineering components. Sometimes there are analytic components. Sometimes there is fieldwork, and intersectioned with, in this case, clinical situations.

Matthew Bonds:

Scientists, I think, tend to be inherently collaborative, but they’ve never been this collaborative. A lot of information is moving faster than you can ever imagine. People are collaborating. They’re writing. They are putting data online as soon as possible. It’s getting scrutinized, and feedback is very public and not very anonymous. The science is moving faster than I’ve ever seen it in my life.

Manisha Thakor:

Switching gears a bit, a number we’ve been hearing a lot at the time of this taping is 2.5%, and that’s in reference to the portion of the global population who has contracted the virus at this point. Yet we’re also hearing another number, 50%, which is the rate of the population that may be exposed. Not deaths, but simply having been exposed or contracted the virus, and that’s a huge jump. How is that possible with all the social distancing that going on?

Matthew Bonds:

Yeah. The funny thing about these is everyone’s heard the term infectious disease modeling in the last couple of months because it was these infectious disease models that actually led to the president’s declaration of a national emergency, and governments all over the world are taking their early models seriously, but you don’t really need a model. You don’t need a great model to get to those numbers. I mean, all you need to know is that you have a virus that people do not have immunity to, that is fairly indiscriminate and transmits in ways that are very conventional. Right?

Matthew Bonds:

This isn’t a sexually transmitted disease network, or something that has to go through fleas and rats, or anything like that that has a lot of idiosyncrasies to it. This is a directly-transmitted disease, for which it has really fast doubling times. So, the number that a lot of people are getting familiar with, maybe the most important epidemiological characteristic of the disease is called the basic reproductive number. This is the number of individuals that the first infected individual will infect when the entire population is susceptible. That is somewhere between two and three.

Matthew Bonds:

One individual who’s infectious will transmit this virus to two or three other people. So, that’s what gives you exponential growth, and with that, just knowing how many people become infected, that alone will tell us pretty close to how many people will get infected in the population before the disease can no longer continue to infect people. Over the course of the epidemic, that number, the term R0 doesn’t actually change, but the term R, the reproductive rate of the disease, that will change because the number of susceptible people falls. Eventually, that will get to the point where one person is only able to infect one other person or less over the course of the infectious period.

Matthew Bonds:

These days, you hear a lot about that. New York thinks that they have an R that is now below one. So if nothing changes in New York, if the policies stay in place, if they stay in lockdown, et cetera, you would see the disease go to zero over time. The challenge is that, is if nothing changes. They’re in lockdown. Lockdown is a really tough position for a city like New York in a state like New York to sustain until there’s a vaccine that might come in 18 months. That’s a problem. If nothing changes, you will not go from 2.5 to 50%, but if you do go back to where we were before, then yeah.

Matthew Bonds:

We’re even closer to that 50% than we were when COVID-19 was only in Wuhan. So, it’s even closer. It’s in our backyard. In that sense, we haven’t gotten far enough away. All we’ve done is shown that if we don’t interact with each other enough, then we won’t get the disease, but how do we get back to life where we can interact with each other is a big challenge.

Manisha Thakor:

Well, to wrap up, given everything that you’ve seen and that we’ve talked about here today, what gives you the most hope as you’re looking forward?

Matthew Bonds:

I would say there’s two pieces of optimism that I like, and I guess there’s probably a few cautionary bits. The main thing of optimism hints at what you were saying before, which is just how much collaboration there is as well. I was part of a working group this morning at Harvard with people on the line, most of them I haven’t known. Some of them working on vaccines. Some of them designing seroprevalence studies, studies for measuring whether people are infected or not, or have antibodies or not. Then some of them on modelers are working in different parts of the world. There’s just this just very broad mobilization, and that people are much more collaborative, and the science is moving way faster than it ever has. That gives me quite a lot of hope.

Manisha Thakor:

And the second thing?

Matthew Bonds:

I think I’m hopeful. God, I really hope that what we leave at the end of this pandemic is a sense of the relevance of science and the interface where the public at large has a understanding of how science is a living discipline, and the process can work effectively, and scientists who are warning about things, heeding those warnings are really important because they’re based on real information. They’re not speculative, and we can appreciate science for what it is, and live with its limitations. That’s the space, and then also scientists become smarter about how we work with the public, and become more responsible and cautious about what we’re … or at least judicious in how we’re communicating what we do. I just see scientists collaborating better together, and the science and the public working better together. Those are the things that make me pretty optimistic. Yeah.

Manisha Thakor:

Coming from the world of finance, my knowledge of science is not what I would like it to be by a long shot. Thus, learning from Matthew during this conversation was like a bubble bath for the brain. What three takeaways did I have? The first was Matt’s explanation of a key concept, the reproductive number or the number of individuals that the first infected individual will infect at the point at which the entire population is still susceptible, and that right now with COVID-19, the number is two or three. With global travel, that two or three easily translates into the creation of a global pandemic. What social distancing does is to try and get that number down to, say, one until a vaccine or other treatment is available.

Manisha Thakor:

The second was Matt’s observation around the degree of global collaboration amongst scientists. In a time during which there’s a lot of highly contentious discourse at a governmental level, I found it heartwarming at a human level to see this cross-border collaboration and its effect, which Matthew put it as, “I’ve never seen science move faster in my life.” My third takeaway? An increased appreciation for the relevance of science. As Matthew referenced, the public at large now has a clear understanding of how science is a living discipline, and has seen that process work firsthand effectively.

Manisha Thakor:

As always in our show notes at trueWELLthpodcast.com, and that’s WELLth, W-E-L-L-T-H, we’ll have Matt’s full-length bio as well as links to several of his websites and articles on his work that are fascinating and well worth your time to come over to the show page to check out. We’ll also have links to Matt’s social media coordinates. Again, that’s trueWELLth, W-E-L-L-T-H, podcast.com. Lastly, if you know of someone who can benefit from listening to this episode, please take just a few seconds to use the share feature on your podcast player to pass Matt’s insights along to them.

Manisha Thakor:

If you’d like to support the show, please take a moment to leave us a five-star rating and/or a written review. Those quick simple steps go a long way towards helping other folks who share your interests to find the show. I’m Manisha Thakor, and that’s it for this episode of true WELLth.

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