‘The Problem Is Tomorrow’s Variants’: Renowned Bay Area Epidemiologist Predicts Prolonged Pandemic

It will take years, not months, to gain the upper hand in the coronavirus pandemic — and it will require thinking well beyond our borders, says Dr. Larry Brilliant.

The 76-year-old Bay Area epidemiologist, who has worked to eradicate smallpox, polio and co-founded the Seva Foundation in Berkeley to combat blindness, has a unique perspective on the subject.

For years, Brilliant warned of a pandemic on the scale of the one we are living through. He even served as the senior technical adviser on the 2011 motion picture “Contagion,” filmed partly at the San Francisco 49ers old stadium, Candlestick Park — during which time he presciently predicted that epidemiologists would become rock stars and stadiums would become mass vaccination sites.

As the CEO of Pandefense Advisory, Brilliant has assisted in the global response to the coronavirus crisis over the past year. He has a broader view of the pandemic than most public health leaders and scientists, having invested his life’s work in anticipation of this very moment.

He is encouraged by dropping case counts, the rapid development and rollout of innovative new vaccines, the new science-driven leadership in the White House. But Brilliant is not here to reassure anyone that this will all be over soon.

“I think there’s a lot of good happening,” he said, speaking to The Chronicle by phone from his home in Mill Valley in a rare interview Friday. “I would prefer to think that things will get better, but the scientist in me worries we’re too perilously close to things going the other way.”

Brilliant, who moved to San Francisco in 1967 from his native Detroit, clearly remembers how he felt the moment he realized, in January 2020, that his predictions were about to come true. He was in a meeting with top epidemiologists and public health policy experts from around the world at the Flood Building in San Francisco when an alarming call came in. The Thai Health Ministry had identified a case of the novel coronavirus at one of its airports.

“Those of us who had been through MERS and SARS, we looked at each other and said, ‘This is going to really bad,’” Brilliant said. “We knew then that this was going to happen.”

As the first leader of Google’s philanthropy division, Brilliant is connected with tech leaders and public health officials worldwide. But in the former administration, he found his efforts stymied, and he was forced to watch from the sidelines as every opportunity to get the pandemic under control was ignored, dismissed and disparaged.

He feels renewed optimism with President Biden in charge, especially with a new federal COVID-19 response team that includes Andy Slavitt, the former acting chief of Medicare and Medicaid under the Obama administration; Vivek Murthy, the former U.S. surgeon general; and David Kessler, the former commissioner of the Food and Drug Administration.

“I think it’s going to be a very different attitude,” Brilliant said, praising Biden’s swift action in securing enough vaccine to deliver doses to every American by the end of the summer.

“We’ve got enough vaccine on order to vaccinate every man, woman and child in the United States,” he said. “We also have enough vaccine to help the rest of the world, which is important.”

He cautioned, however, that it will take a global effort to truly make an impact, especially to head off increasingly aggressive variants of the virus that could elude testing and vaccines.

Even if the United States gets most people vaccinated, it won’t be enough, he said: “Until everybody in the world is safe, no one is safe.”

The virus does not recognize borders, and variants such as those discovered in the U.K., Brazil and South Africa will continue to emerge until everyone is vaccinated, he predicted.

Brilliant, a longtime Grateful Dead doctor, laments that half the country still believes in an America First policy, and that kind of nationalism will create an “uphill battle” in the quest to wipe out the pandemic.

While he is confident that the vaccines in production now will be suitable to combat the variants in circulation, that picture could rapidly change.

“Today’s vaccines are good enough to stop today’s variants,” Brilliant said. “The problem is tomorrow’s variants. We’re just on the cusp.”

He thinks that the global picture of the pandemic is much more dire than the numbers show. There have been more than 100 million cases of COVID-19 reported since the start of the pandemic, according to data collected by Johns Hopkins University. Brilliant predicts the actual number of cases will top a billion, “without question.”

As government leaders rush to reopen the economy and schools while the pandemic continues to rage Brilliant urges caution.

“People are beginning to think, ‘Well, I can go hug my granddaughter,” he said, noting he rarely ventures out of the home he shares with his wife, Girija Brilliant. “The psychological letdowns people will have are going to be tremendous.”

He said the three surges we experienced last year may not have been surges at all but a portent of what is to come globally.

“There’s a nonzero probability that we’ll look back and all those three bumps will all together just be the first wave, and what’s coming next could be worse,” he said. “I think the future is really complicated.”

Brilliant, who said Thursday that he was set to receive his second vaccine dose with his wife on Valentine’s Day, said people should continue to follow public health protocols for now, including masking, physical distancing and staying home except for essential outings. He said not enough is known about the vaccines to be sure that even after people receive their shots, they will be unable to spread the virus.

“As a country, we’re still not vigilant enough,” he said. “When you meet the people who have long COVID, and a year after, they still wake up some night unable to breathe, they still have swollen toes, they still have difficulty focusing. … If I can use a technical medical definition, this is really a s—ty disease.”


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