Editors’ Note: Deadline’s latest series, Reopening Hollywood, focuses on the incredibly complicated effort to get the industry back on its feet while ensuring the safety of everyone involved. Our goal is to examine numerous sides of the business and provide forum for leaders in Hollywood who have a vision for how production could safely restart in the era of coronavirus.
Right now, the burning question for so many is, “How can we safely go back to work?” Since TV and film production necessitates physical proximity, and often precludes the wearing of protective masks, the future of the industry hangs in an uncertain purgatory. Conflicting information abounds, with different drugs being touted, a vaccine way off in the distance, and mystery surrounding the accuracy of antibody testing. In an attempt to clarify some of this, Dr. Michael Smit, an epidemiologist and designated CDC expert who served as a medical consultant for National Geographic’s Ebola outbreak series The Hot Zone, breaks down where we’re really at right now and what it might take to get back up and running.
DEADLINE: Without a vaccine coming in the near future, is it realistic to have parameters in place where you test people daily? What would you say to people who work in production where they have to be in close proximity?
DR. MICHAEL SMIT: The testing capability and significance at this point is not straightforward. Right now, there are two different tests that are available. Broadly speaking, one is where they do either a swab up your nose or in your mouth and they test for the presence of the virus there. That’s called a PCR test. That will tell whether or not you are infected and that you are shedding the virus. It’s important to understand that when they do that kind of test it can also pick up small fragments of the virus. So, it might not be entire viruses that can then infect people, it just might be pieces of broken up virus that your body is getting rid of.
The other test that they’re talking a lot about is the serology test, where you test your blood to see if you have antibodies. What they know from previous infections that we’ve developed vaccines for, is that people with certain diseases, if they have positive antibodies, they are resistant to the infection coming back. But right now, we don’t really know what the significance of the antibodies are with the coronavirus. There are studies coming out of China showing that there are people who are still shedding virus, but when you test their blood they also have positive antibodies. So, there’s a little bit of a disconnect there because it’s thought that if you have the protective antibodies, you shouldn’t be still producing the virus.
DEADLINE: So, we don’t know yet if the virus is behaving the way other viruses do in terms of immunity. Without the certainty of antibody testing in place, what does this mean for the industry?
SMIT: As far as how that applies to the film industry or entertainment industry in general, you can do a PCR test and that can tell you whether or not you’re actively shedding virus at that time. However, that doesn’t mean that a couple hours later you might not be shedding virus, or the next day, or the day after that. There’s also concern based on symptoms, because now they’re finding that there’s probably a certain amount of people when they get infected that they have minimal symptoms or no symptoms at all. We really don’t know if those people can infect other people or how infectious they are. Right now, the only options that we have for people who are trying to get back to work are physical distancing. So, trying to say 6 feet apart, and then hand hygiene. It’s understandable that in the entertainment industry, that’s really difficult because you have to get closer to people to do that. There isn’t a really good answer on how we can do that safely.
DEADLINE: OK, so how about testing every single person on a film or TV set every day?
SMIT: First of all, we don’t have the number of tests to be able to do that. Also, for some tests, it takes days to get the results back. There are some tests out there that are rapid that can be done in less than an hour. However, they’re in limited supply and some of them aren’t as sensitive as the regular tests. Which means that you wouldn’t be able to pick up lower levels of virus.
DEADLINE: What about developing those tests to make them more accurate so that we might see a way forward? I also heard some scientists are creating a portable DIY device so people can read their own tests. What’s the possibility of making these things accurate before we get a vaccine?
SMIT: I do think that there’s potential for us to have more rapid, more accurate testing, but those things take time to develop and validate. I think that we will see in the next several months the ability to have rapid testing, in an hour or less. The question is whether or not we could scale that up to be useful, to have enough quantities when and where we need it.
DEADLINE: This is not egalitarian, or ethically sound, but will we see circumstances in which high-budget productions will pay their way to daily rapid testing? Are we seeing private companies working to provide those tests for the right price?
SMIT: Yeah. That already has been happening. There have been people in the greater Los Angeles area who have great resources, many who are connected to the entertainment industry, who have concierge doctors who are able to get them testing on an individual basis. This is a very controversial area because right now these tests are a limited resource. For instance, at my hospital, we reserve the rapid tests for children that need lifesaving surgeries, and we need to know whether they’re positive or negative right away. So that’s a very controversial thing for somebody just because they have a large budget for production to get a limited resource like that, when literally patients might be dying in the hospital because they don’t have that test. But I wouldn’t be surprised at all if that ends up happening. Because I do think that the supply of the tests will increase in the next weeks to months, and people with resources will be the ones who are able to get hold of those tests.
DEADLINE: We’re hearing suggestions of taking temperatures in workplaces or at stores, but that seems pointless when not every infected person gets a fever.
SMIT: Taking temperatures as a screening tool is a very controversial subject. When I was in Sierra Leone in 2014, I worked at an Ebola treatment center for seven weeks. And part of the screening that they would do at the treatment center was they would take your temperature. The thermometers that they use are the infrared ones, shaped like a gun, and they’re notoriously inaccurate. So usually my temperature would be 5 degrees below normal, because they’re that inaccurate. Also, when you look at studies of taking temperatures as part of screening at airports or stores, they’re incredibly inaccurate. In my opinion, it’s a waste of time and resources. Depending on what study you look at, anywhere from 20%-40% of the people that were infected did not have fever. I think it’s more of a psychological booster that shows people that we’re doing something, where in reality it’s probably not helping that much. People respond a lot better in a crisis situation when there’s actually something they can do to help. If you just tell people to do nothing, then that increases the anxiety level and it isn’t productive.
DEADLINE: Can you explain in layman’s terms why it takes so long to create a vaccine?
SMIT: It’s actually a very complicated and time-consuming process to roll out a vaccine. It starts off in the laboratory where they try to figure out a way for a vaccine to be developed that would create antibodies. They have to basically break down the virus and find targets that they can look at that the vaccine would address. If you can imagine a virus is like a sphere that has spikes or bumps coming out of it, the point of the vaccine is to develop something that looks like those bumps or spikes, that your immune system will recognize and then develop antibodies against. So, they have to do the laboratory component first, where they do all that stuff in petri dishes and test tubes, and then they have to roll it out to either animals, or humans, or both, where they do trials to make sure that the vaccine doesn’t cause harm. And then they have to do more trials to see if it is protective. And then once that happens then they can roll it out to the general public. And so those paths typically take anywhere from 12 to 18 months to complete safely.
DEADLINE: There’s no way to fast track it? That’s a fantasy?
SMIT: It’s a fantasy unless you really want to compromise safety. You could end up with a vaccine that causes more harm than good.
DEADLINE: What are your thoughts on hydroxychloroquine? There are some mixed messages.
SMIT: Whenever you roll out a new medicine, again, what you want to make sure is you’re not doing more harm than good. This is the danger when you have politics intertwined with medicine. I know that there were certain political figures in this country who were promoting hydroxychloroquine. And this was really done before the data was out on the safety, and they actually found that it was not a safe drug. In some of the trials they had people who died because it caused a disturbance of their heart rhythms and then people would have heart attacks and die.
DEADLINE: But I’ve actually taken hydroxychloroquine before as a malaria drug while traveling, and lots of people take it.
SMIT: So, most people who take it, they don’t have a problem, but a certain percentage of people will. And when you talk about rolling out medicine to hundreds, if not thousands of people, there’s predictably going to be a certain number of them who are going to have a bad reaction.
DEADLINE: What about remdesivir?
SMIT: So that’s a new antiviral that they just completed a study on that was very favorable, and I think that’s one that will gain traction in the next coming weeks. The challenge will be whether or not they can produce it and actually use it therapeutically. But my understanding is that the additional data from it is favorable.
DEADLINE: At what point would you feel confident in offering this antiviral to patients? What’s the protocol?
SMIT: Practically speaking, patients who have mild to moderate disease who are admitted have not been getting anti-viral treatment. They’ve been reserving that for people who are severely ill. What we’re waiting for is recommendations from the FDA and CDC on safety parameters so that we know when to give the medicine and what to look for. For instance, it can cause certain side effects that we want to keep a close eye on. As soon as we get that approval and it’s available, we would use it as needed.
DEADLINE: What’s the bottom line right now then? What’s your advice to people working in this industry? How long are we really looking at?
SMIT: The big thing that I’m interested to see the outcome of is the results of all these serology studies. If you develop antibodies after being infected and that those antibodies protect you, that will be a huge game changer. We don’t know that yet now, but we might know that within the next couple of months. That would mean that people who have antibodies when they get tested will be protected and won’t have to worry about being re-infected. It’s much too early for us to make a conclusion on that. If that does happen, then gradually we will be able to reintegrate our society to where the physical distancing won’t be as important, and then in the entertainment industry where you have to be close together, you will be able to pick up and resume activity. In the meantime, we’re waiting for the vaccine which as you know is 12 to 18 months away. And then we also will have this in the background of increased ability to test for the actual virus with the swabs. And those tests will be more available and will have results more quickly, probably within the next months, plural.
DEADLINE: Are we talking six months? Longer?
SMIT: That’s really tough to predict. It’s not clear to me when we’re going to be able to ramp up our testing capability so that it’s just everywhere on demand, but I’m hopeful that within the next perhaps three months we get to that level with the test where you get a result in less than an hour.
DEADLINE: I think people have been assuming that the antibodies stick around and protect us at least for a while once we’ve had the virus. It’s a shock to learn that there is no real confirmation of that yet.
SMIT: Yeah. If you look at the way humans respond to virus infections it’s different. So, for instance, if you’re infected with measles or chicken pox and you recover, you’re immune for life so you don’t have to worry about that. Whereas other viruses, when you get infected, it only provides partial immunity and you could get it over and over again, but not right away. So, for instance, we know that some of the other coronaviruses that we’re familiar with, provide a partial immunity where you’re immune for about a year. You become susceptible again, so you can get re-infected. The theory is that this coronavirus might be one of those where you get immunity for a little while, which may be months to years and then you could be re-infected.
DEADLINE: Right. But that might buy us enough time to get the vaccine. We could then have herd immunity for that year while we wait, but that relies on almost everybody having had the virus, which is obviously far from ideal as well. And we’re not going to get to herd immunity while we’re isolating. So, it’s a bit of a chicken-and-egg situation.
SMIT: It is. And if you look at countries like Sweden who chose not to do the physical distancing thing and just pretty much did business as usual there, their fatality rate is much, much higher than the other Scandinavian countries that have similar populations. Like you said, it’s a chicken-and-egg situation.
DEADLINE: What do you think about President Trump wanting to re-open very soon?
SMIT: I personally would be against that. I think that we need to continue with the physical distancing for some more time. Like look at the meat-packing plants, if you’ve ever been to a meat-packing plant, it’s a very tough work environment. People are right on top of each other, so it’s really hard to maintain physical distance in situations like that. And so, for me, I think it’s a little bit irresponsible to ask these workers to go back to work where all the people who are making policy decisions are safely protected behind walls and tested frequently.
DEADLINE: Are we looking at something like the Spanish Flu that lasted for several years? You can’t starve the virus out of existence really, can you?
SMIT: No. What I think is going to happen is that we’re going to see several waves go through worldwide. And a lot of it’s going to depend on the individual countries, the way they did their lockdown procedures. So, there’ll be pockets of people in all these countries that have not been exposed and so you’re going to see secondary, third and fourth waves that go through. I think that there are going to be certain things that are going to be changed in society forever. One of them will be how people interact with each other personally. Are people going to shake hands anymore? It’s a real possibility that’s going to go away. Or people going away from movie theaters or places where you’re very crowded. Those types of things might be phased out or changed into a version that we really aren’t familiar with or don’t recognize.