Emory Infectious Disease Professor Sees More Danger Ahead

When Dr. Phyllis Kozarsky first arrived at the Emory University School of Medicine in 1984, the country and the world was in the middle of another frightening epidemic that was caused by the AIDS virus. She helped treat some of the early victims of that disease and help to train doctors to diagnose and treat the disease.

For 34 years she was a professor of medicine in Emory’s Division of Infectious Diseases following the ups and downs of medical crises around the world. She was co-founder of the International Society of Travel Medicine.

Today she is a consultant in the Division of Global Migration and Quarantine at the Centers for Disease Control and Prevention in Atlanta. Yet with all she has seen in her long career, for her, the COVID-19 pandemic has been a unique experience. “I never believed that a medical crisis could be this tragic.”

AJT: Why are we seeing such an enormous number of new cases in Georgia?

Kozarsky: I fear that perhaps the way in which we’ve opened in this state to such a great extent has made people feel as though it was over. All of a sudden restrictions ended, perhaps without the kind of messaging that the public has really needed, the kind of trusted talking head, if you will.

AJT: What do you mean?

Kozarsky: What we needed was what they called the “fireside chat” that helped America get through the Great Depression. It was where a trusted person would say: “This is what we know, and this is what we don’t know. And because of this, this is what we’re recommending today. This may change tomorrow but we’ll be back with you tomorrow if we learn something different.” I think we have all missed that.

AJT: And do you think this is going to be with us for a long time?

Kozarsky: I don’t know what a long time is, but yes, it’s not going away. This country is really not in very good shape. Some European countries have done much better.  Frankly, I’m most worried about what’s going to happen this fall and winter as we go into flu season. We just don’t know if this will take off again in wintertime, along with the flu.

AJT: So could you have a flu infection and get this on top of it?

Kozarsky: I don’t see why not. Yes, two very, very different viruses infecting the body at the same time. Sure. That’s certainly a possibility.

AJT: There is a report that Chinese researchers have found a new type of flu in pigs that has infected humans and could have the potential to cause a future pandemic. How important is that discovery?

Kozarsky: There are lots and lots of different kinds of viruses. And there’s lots of mixtures among animals because of the association between animals and people. There are live animal markets and things like that. So there’s always a concern.

AJT: What is there about the virus that is currently causing our pandemic that makes it so difficult to contain?

Kozarsky: The really big difference that wasn’t very much accepted until more recently is the fact that there is so much asymptomatic and pre-symptomatic spread. And that did not happen in the SARS virus epidemic of 2003. In the earlier epidemic, as soon as you got sick, when you would be able to transmit it, you went into isolation so you weren’t able to transmit it to others. There were only about 8,000 cases worldwide and only 800 people died then.

But in 2020, people who got sick weren’t always exposed to somebody who appeared sick. And we realized that, lo and behold, it can be transmitted when people are feeling fine before they have symptoms. It can even be transmitted by people who never get sick and that’s a huge thing. So how do we know who should be in quarantine or who should quarantine themselves?

AJT: There’s been considerable controversy about wearing masks. What advice would you have to help us understand what we need to do to protect ourselves.

Kozarsky: We’ve shown that physical distancing does help, that masks do help. And certainly it’s a way of helping prevent the spread to other people. And one would wish or hope that that both sides on the question of masks would understand one another. Those who are more vulnerable would understand the fact that some people perhaps are unable to wear masks or may not want to wear masks, but that people who are not wearing masks also understand and have empathy for those people who are more vulnerable.

I think we each have to determine our own risk tolerance and we each have to do what we feel that we need to do that’s best for ourselves and our families. And so my husband and I have are basically self-quarantined. My husband calls me Orthodox.

AJT: Meaning you stick to the rules.

Kozarsky: Yes, I do. I’m vulnerable. I’m of a certain age and I am not the healthiest person. And I understand that I have to take responsibility, my own responsibility.

AJT: And what would you say is the single most important thing you do? Wear a mask? Social distancing? Wash your hands?

Kozarsky: No, I try to maintain a sense of humor and I try to keep my perspective and be thankful and grateful every day that I’m here.