Interview with Dr Faheem Younus, Chief of Infectious Diseases, about Covid-19: “We are like warriors in a battle with scissors and knives in our hands and then the other side has F-16 and tanks.”

The Review of Religions conducted an interview with Dr Faheem Younus, who is Chief Quality Officer and Chief of Infectious Diseases at the University of Maryland UCH, about the current Covid-19 crisis. For up-to-date advise on the these fast changing conditions, Faheem Younus recommended going the WHO website. The Interview was conducted by Sarah Waseem and Farhat Mahmood.

S: Dr Faheem, Assalam-o-alikum (Salutation: May peace be on you)

F: Walai-kum-a-Salaam (And may peace be upon you)

S: We have had many pandemics before such as SARS and swine flu, but none of them seemed to have resulted in the kind of global containment measures that we are seeing now – shops being closed, transport affected. What is it about Covid-19 that is so different? 

F: It is an excellent question. So first of all I think the simple answer is impact. If you think between January and February, all that people were saying was, “this is another kind of flu, it just causes 2% mortality”. That 2% number was very misleading. When you go back to SARS, which happened in 2003, it had an 8% mortality. But when you look at the total number of people that died in the world with SARS, it was less than 900 people. With Covid-19 right now, the death toll is over 26,000. So what Covid-19 in three months did, SARS could not do in 2 years. So the question is why? How come this virus is so lethal?

So much has changed in the world over the past 17 years, for example, global travel. If you look in 2003, about 1.5 billion people were travelling annually around the world. Now the number is over 4 billion. You can see how this virus spread far and wide. Another data point is the ceasing of travel from Wuhan, China. The virus probably erupted somewhere in November or December, we don’t know the exact point, but let’s say it was in December. You go back and look at when the travel restrictions were put in place and it was not until January 21^st. So by January 21^st when we put a lockdown in Wuhan, more than 7 million people had travelled out of Wuhan by that time. When you put these numbers together and then you look at that 2% mortality and you compare it with regular flu, (I don’t know about the U.K. but in the U.S., influenza kills on average around 35,000 every year), coronavirus’ mortality is 10-20 times more than that. That means we are potentially looking at half a million people dead in the U.S. 

The bigger problem is the comorbidity that it causes. About 10-15% of the people will require hospitalisation. If only 10% of the U.S. population was to get infected with the virus, (which is unlikely, typically that number is much higher than that), that will mean 6 million hospitalisations. We have 5000 hospitals in the whole country, so think about it: 1000 extra patients for every hospital. So these are the reasons why this is such a big deal. 

I am saying that this is death by a million paper cuts. What is happening here is that multiple small factors that have just come together in a way that they have gained momentum. So first you have a novel agent- a new virus that comes from an animal kingdom and infects humans, and humans have never seen it before so our immune system is caught off guard, we don’t have immunity against it. Secondly, it happens in the most populated place possible. If it had happened in Maldives, an island, the chances are it would have never have gone anywhere in the world.  Wuhan is a city larger than New York City- New York City has 8 million people, Wuhan has 11 million. Third, it happens around New Year, the peak travel time and then there is the Chinese New Year, and the fourth is that it doesn’t get detected for 7 or 8 weeks.

I am not criticizing the Chinese– I think it is very, very hard to detect a new pathogen– so I think they have done a phenomenal job,  and then you add the mortality, the morbidity and the efficiency of this virus. Each person infected with influenza is likely to pass it on to 1-2 people. With Coronavirus we are going to pass it on to 2-3 people. Now that may look like a small difference but when you project it on populations and you go through the third, fourth, fifth cycle of the virus, that’s hundreds of thousands of people. So there are multiple factors all aligned together and that’s why you’re seeing the kind of impact that you are seeing. 

S: That’s very helpful. On social media, you have spoken quite a bit on your Twitter account about some of the myths that need to be dispelled about the virus. You’ve gone into a lot of detail about that. Could you tell us what you think is the most important one of those? 

F: God knows, I have no idea! I will tell you why I am doing it before I can tell you which one is more important! I could not keep pace with my text messages and the Whatsapps and the phone calls that I was getting – friends and family and members of the Ahmadiyya Muslim Community and from work – because everybody was worried. I cannot keep pace with the degree of questions that I am getting, many of which were just myths. Eventually my daughter said, ’dad, you should tweet about it because many of the folks are on Twitter.’ So, that’s why I started tweeting about these myths and received responses all over the world. That sort of made me realise that look, this is a service. I think there are lots of people who are facing these questions. Two or three weeks ago, the media cycle was all talking about the summer months– that the virus will go away then. So back then, that was the most popular myth. And I thought, if you asked me 2-3 weeks ago, I would say that would be the number 1 myth. But then, a week later, the whole ibuprofen story , started from France. And then again, this was a British doctor, I think their ENT society, talked about the loss of smell – if you have loss of smell, you have Covid. Come on! You, know, I have family members who have loss of smell for years! I don’t want them to die of this panic. So it moves with the media cycle I believe. 

S: As an Ahmadi Muslim – you’re obviously in the front line of this – how has your faith helped you in how you react in this difficult time? 

F: Yes, I am glad you asked that because one of my partners reached out to me the other day, he is also an infectious disease specialist and a very, very smart man. And he said, I am going to ask you a question and I know the answer, but I am still going to ask. I had no idea what he was thinking. He said, ‘aren’t you scared’?So, I had a biggest belly laugh and I said, you told me you already know my answer. You tell me, what’s the answer? And he said, I know you are going to say “no”. And I said, that is the right answer. So he asked me, why? And I told him, look, as a man of faith, I think about my mortality quite a bit, even during regular times. And again, I didn’t want to sort of drown him in jargon…but you know again I think that is what our Khulafa (Caliphs) have taught us. That’s what the core teaching of the Promised Messiah (as) is. What does taqwah mean? It’s the fear of God. It’s awareness of God in my opinion and ‘God consciousness’. So, I do think that if there was no faith, there would be no fun. I really think that this is an inspiring moment. I am not afraid being on the frontline, actually I am exhilarated. I have found more purpose in my profession. There were days, there were weeks and months where I felt like a robot, just coming in, seeing the same patients every day, even though you are still working to help people. But the degree of help that we can offer these days, the degree of comfort we can offer people, I think it directly links to faith. So that’s a very huge topic, how faith becomes a part of it but I must say that it is right, left and centre.

S: Here, when I have spoken to doctors where I work, or healthcare workers, and also on the media, we are hearing a lot of doctors talking about the sense of frustration on what’s going on and their sense of despair and their sense of almost being traumatised by the amount of death they are seeing. And I wonder, what you might say to those who won’t have that faith background?

F: See, I am not traumatised by death and suffering because if I could prevent every suffering, I would have been able to prevent my own parents from dying. The reality is we all go at some time. I do get frustrated. I do have my angst, but my angst comes from the lack of resources. As a doctor, I do not have enough tests to provide help to my patients. Despite living here in the powerhouse of science and economy in USA, we don’t have enough facemasks, we don’t have enough N-95 masks, we don’t have enough protective gear for my own team. That’s what frustrates me. We are like warriors in a battle with scissors and knives in our hands and then the other side has F-16 and tanks. So, that is where my frustration comes from, that I am unable to help my patients, and on the patient’s front, I don’t have a treatment and I don’t have a vaccine. So you see how handicapped you are. As physicians, we are designed to operate in this ecosystem for very strong infrastructure, where everything you see in these TV dramas, where within minutes in an ER we will open tests and we will do CAT scans and we will put a hand in someone’s chest and squeeze their heart until the trauma surgeon arrives. So when those people are shackled by a lack of resources, I think there is some frustration associated with that. But as far as the death and the dying and the suffering, I think our job is to do the best. The rest is in Allah’s hands, and I like to treat my patients as if they are my family and that’s why I gave the example, that both my parents died in front of me and there was not much I could do and that’s the perspective I like to keep. We are here to help people but as doctors, we die, our own family members die, so that’s the part of life.  

S: Thank you. How come we didn’t plan for this pandemic? How come across the world we didn’t plan and how could we prevent the next pandemic?

F: That’s an awesome question and again, I don’t know. How do I give you a soft answer? You know really, we are the foot soldiers, the doctors and nurses, we’re not pandemic planners, I don’t control billions of dollars. This was the job of leaders, right? If you look at the Ted Talk that’s been circulating everywhere these days, Bill Gates predicted this five years ago. Now when people look back at it, it was absolute pure genius. But I think the reality is between money and power, and narrow self-interest sometimes the purpose gets lost and that’s all I can say. I believe between our narrow self-interests and fame, and money, and just power and all and ego, most of all, perhaps above everything. When recessions are driven by those motivations it’s very hard to plan for something that is so unified. You know, look at how unified this virus is against humanity. The virus is not asking the questions you’ve written. Are you British, American, Ahmadi or a Shia? Are you black, white? Are you a man, woman? Are you rich or poor? The virus is such an ethical virus I would say, it simply asks a simple question; are you human? That’s it. And here we are as mankind – we are divided and pandemic planning requires unified thinking. Where is the unified platform? On which platform are we making global decisions? That’s what Hazrat Mirza Masroor Ahmad, Worldwide Head of the Ahmadiyya Muslim Community (aba) has been saying for the past at least twelve years. I remember him talking about these things. That the UNO is sort of defunct, other nationalistic governments are coming up. So unfortunately, I think that’s where the burden lies. But if you ask me, were the warning signs there? Yes they were there. Was the world warned about this threat? Yes the world was warned. Was there was political will to do something?I don’t know. 

S: Thank you. One of the other realities we’re possible facing is that self-isolation may not be a solution, for six months, a year, and also we’re hearing about the fact that self-isolation may work but then the virus may come back again. I wondered what your thoughts on that were and are there any strategies going forward?

F: Absolutely. So they say how do you eat an elephant? Do you eat it one bite at a time? Here we have an elephant we must swallow. So I wouldn’t, I think anyone who claims that self-isolation or social distancing is the only solution, that’s an over simplification. 

So we need to work backwards. How far are we from treatment or a vaccine? Probably one and a half, two years back. So the likelihood of a vaccine or treatment is eighteen to twenty-four months out. So the next question is, we need a strategy to take mankind through the next eighteen to twenty four months, to get them through this period with the least amount of damage. Because that’s the strategy, how do you make a bridge between now and twenty-four months? The first thing will be self-isolation or what I would call social distancing for three weeks. Let me just play the scenario because these are the things I think about very deeply all the time. 

There are three strata typically of any society: there’s a top echelon, people who have lots of money, there’s a middle part that can just hang on for three weeks, and then there is a third. So the lower third that is really going to struggle, the government should help them out, the rich people should help them out. They should create a social structure where they don’t feel compelled to come out of their homes because they will die of hunger. During those three weeks while people are at home, we work intensely on making testing accessible. We make millions and millions of gowns and gloves and commission every Nike factory, every GAP factory, Under Armor, etc. to simply be making PPE. This is a mankind driven initiative. When this started in Singapore, a country of about 5.5 million people, within weeks, Singapore had put together 900 testing stations. If they can do that, why can’t London, or New York? So after those three weeks are over, we should have a testing capacity that will enable us to give home tests. People should be able to tested in drive-thrus, in malls, in all public places they should be able to get a test. Now you test 10%-20% of the population and you start picking all those who are what we call ‘asymptomatic carriers’ or those who are not overly sick, but are infected and you isolate them. You let the society move on. If I am an asymptomatic carrier but I am a bus driver, or if I’m an asymptomatic carrier but I run a day care centre- it’s very important to identify that person. So then you will go with a targeted strategy. You will simply isolate those people who are asymptomatic carriers and you will let society move on. And you will continue to do that targeted isolation, test, isolate, test, isolate, but in a targeted fashion. You will do that for 14 or 16 months until you get to a vaccine or a treatment. So it’s not social distancing, but a three pronged approach – social distancing, then testing, then quarantining and then getting to a treatment. 

Along the way there are many other nuances. Hopefully in a month or two we will get serological tests, which will help us find out who is immune. So that only tells us who has been exposed to this virus, whether they were deathly ill or asymptomatic, and once we find hundreds of thousands of those people who I believe exist, then we can take their serum and from their serum we can make drugs which will be a sort of passive immunity so we can infuse those antibodies into people who are really sick in the ICU. So we can start saving lives right there by identifying people who have already recovered.

Along the way we have to certainly use the communication channels give people hope. We  must make sure people understand that mankind will be standing after this thing is over. And of course as Ahmadis we believe in that reassurance as Hazrat Mirza Ghulam Ahmad (as), the Promised Messiah (as) as has already talked about the future of the Ahmadiyya Muslim Community in three hundred years. So I do not have any worries about mankind. But of course we have to tell them in ways that they can understand. 

S:  Thanks. How important is it to have a healthy immune system with this disease? 

F: Yeah, so at baseline we’re all equal. No one has antibodies against this virus. It’s a novel strain. Now the next question is, going back to the house fire analogy, every house is equally prone to the fire. A better immune system would be like a house which has less wood and more steel, so that house will be more protected from the fire and that’s true for people who are in good health, people who’ve taken care of themselves, who exercise and who don’t have five other diseases, who are taking good sleep and I would even go as far as to say, also those who are positive in their outlook. I think all these things will help.  In a year or two, we will do a post-mortem to see how it impacted different parts of the world. Sometimes when I look at previous pandemics, I don’t see a very varied pattern – typically it’s similar across the board but we’ll see what happens this time. 

S: People are also talking, certainly in this country, about the impact of this pandemic on mental health. You’ve mentioned about the need for a positive attitude. But many are likely to suffer trauma, grief – people will lose relatives. In terms of the frontline workers and the trauma they will have been through. Have you had any thoughts on that going forward?

F: It’s a very difficult question because I think human beings are very complex machines. We have our own world view and at this stage everybody’s going to suffer in the way that they have lived their life and they’re going to heal in the way they believe in whatever future they believe in. So as they say in nature there are neither rewards nor punishments, there are simply consequences. So unfortunately I feel there will be a lot of consequences for us as mankind, which means if I had a mental illness to begin with, it’s likely to be exacerbated and if I had a tenth of the problems in life that I was already managing and this occurs on top of it, it’s likely to make it difficult for me. If I live in a country or a society, which is very individualistic, I’m going to have a very different experience compared to if I live in a society that’s more communal. For me, the Ahmadiyya community is like a mother’s lap. For us who have Khilafat (Caliphate), who belong somewhere, I think our resilience is going be very different. We now have the opportunity to give back now that mankind is suffering.  We know people are suffering and like the virus that does not discriminate who it attacks, we can help out indiscriminately. I think there’s a beautiful opportunity in this crisis, particularly for people like us who have been blessed with this sort of spiritual immunity, that I would say this is a spiritual immunity that Allah has given us a very different grounding in this world. So maybe that’s what we should be doing, but there will be a lot of suffering, there will be a lot of depression, isolation, PTSD and I hope we can empathize with that and not just blow it off. 

S: Just as a final reflection, I don’t think the world is ever going to be the same again.I wonder if you have any final thoughts about that. 

F: It’s very difficult to answer. It scares me to predict how the world is going be. Again I think it’s the way I look at it. Smart people are taking a look inwards and taking lessons and learning from those lessons, and the not so smart people end up blaming others, don’t change their behaviour and for them life moves on. I strongly believe in treating this as an opportunity. That’s what the whole notion of suffering is about. Hazrat Mirza Tahir Ahmad, Fourth Worldwide Head of the Ahmadiyya Muslim Community, has explained it in his book Revelation, Rationality, Knowledge, and Truth as to how there is so much opportunity in suffering. So the question is who is going to use that opportunity and make good use of that opportunity versus not so good use? So I believe there will be a spectrum. Some will learn something from this and their lives will change forever. I think that will be a good thing. I wish actually, that the world is a different place moving forward. But I’ve seen so much suffering in my life and my experience is that some things just never change unfortunately but change is in our control. This is applicable to me, to you, to our Community. His Holiness, Hazrat Mirza Masroor Ahmad (aba) guides us every week about the things we should be doing, and what is good for us, and whether we like it, or accept it or not, we all have a varying degree of response to that; there’s a spectrum. And on one end are those who will just absolutely just align themselves with it and on the other extreme are people who would continue to live their lives. As a Community, I would really wish and hope that if all of us as a Community would move a little bit more towards the message of His Holiness – maybe it’s an inch for one and one mile for another. I keep thinking about His Holiness’ question and answer session, where he voiced his biggest worry- when that breakthrough (people will be in search of God) happens are we going be ready? So maybe this wakes us up and we become a little bit more ready for that. That’s all I’ll say. 

S: Jazakallah. I don’t think I have anything to add, I mean I find your answers incredibly thought provoking. On behalf of The Review of Religions just want to say thank you so much. We have so much respect for you all on the frontline working without sufficient equipment and you have families who I am sure are worried about you. So God Willing we pray for you thank you so much for your time. 

F: No problem, my pleasure. Jazakallah.