One Year of COVID-19

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0:06 Joe Eisenberg: This is really unprecedented, ahistoric. This situation, really, we haven't experienced before.

0:13 Narrator: That’s the voice of Joe Eisenberg, Professor and Chair of Epidemiology at the University of Michigan School of Public Health speaking on this podcast one year ago. Back then, he was the very first guest featured on our special edition COVID series. Today, 44 episodes and almost exactly one year later, Dr. Eisenberg is back to talk about where we've been and where we're going with this unprecedented pandemic.

0:38 Narrator: Hello, and welcome to Population Healthy, a podcast from the University of Michigan School of Public Health. This episode is part of a series of special editions of our podcast, focusing on the ongoing coronavirus pandemic. We ask Dr. Eisenberg where things stand today, in regard to COVID in the United States.

0:56 Eisenberg: It's been a very devastating pandemic, unparalleled since 1918 Influenza pandemic, but we have made tremendous progress. The development of the vaccine occurred in record speed. The risks are still high. It's becoming much more of a known risk to people than it was before. I think, on the downside, the pandemic fatigue is also kicking in. People are interested in being able to get back to some semblance of normal. We talk about the new normal, where we'll be doing things differently than we did pre-COVID, but we see the light at the end of the tunnel, at this point. Vaccine ramp-up is only gonna be getting better and increasing and improving. We've got an administration now that is really taking this seriously, and therefore, I think there's gonna be some very positive breakthroughs with respect to just the supply chain part of the vaccine. That was true early on, with respect to testing. We didn't have the people to do the tests, we didn't have the supplies to do the tests, and it was a big scramble to get that increased testing capacity. Now we're doing the same for the vaccine, really hitting, right now, the high risk populations. And the whole goal behind the vaccine strategies right now is to decrease the mortality, decrease the hospitalizations. And later on, as we move into the general population, our goal would be to decrease transmission and actually move towards herd immunity.

02:23 Narrator: We wanted to know what has surprised him the most about the past year?

02:30 Eisenberg: We've been able to better understand what it takes, in our society, to be able to control a pandemic of this magnitude and this severity. I think that a lot of the critique and politicizing of the pathogen and this infectious disease, though probably, in retrospect, not surprising. I think if you read up on your history, 1918 flu, the Influenza pandemic, the same thing was occurring, but a little also surprising that a disease that transmits and can cause severe outcomes would be political. I think that's, in my mind, disheartening a little bit, and a little bit surprising. It's a smaller and smaller minority of people that are not using masks at all. I think, if you look across the aisle, you see Republicans and Democrats are wearing masks. There is some coming together that this is a pathogen that can be transmitted, it can cause disease, it can kill people, and that mask can help prevent that from happening. We're social creatures so we wanna get together and socialize, and it's hard to not do that. Even if it's not a political statement, that's a challenging part of this pandemic, is that the ways in which we can best control this disease is through social distancing.

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03:51 Eisenberg: I still think that it'll take some years to tease apart and really assess how this respiratory coronavirus is unique and different. It's certainly unique to the other coronaviruses that are endemic, just cause more upper respiratory disease and part of the suite of viruses that cause a common cold. And this has lower respiratory pathology, much like influenza, and so it's surprising and different in that respect.

04:17 Narrator: When the new vaccines began to roll out late in 2020 and early in 2021, public health guidelines were used to prioritize their distribution across the country.

04:26 Eisenberg: It's not like those with all comorbidity are all in the same risk category. That's not true. Same with age, right? It's not like everybody over 65 is in the same risk category. It's too logistically-complex to really rank everybody by their particular risk and just have a list of 300 million people in order. That just doesn't work. That's where we say, "Well, okay, everyone over 65 is at a high risk." There's a big jump, and we're just gonna categorize them all at once. And then we have a list of comorbidities that we see have elevated risk. We're gonna lump all those together. Same with essential workers. We don't necessarily differentiate one essential worker, which could have high risk of being exposed, and another, we just say, "Okay, these are all the essential workers we want to be vaccinated." In general, anything that could compromise your immune system could put you in a high-risk category, so it doesn't have to be just respiratory-related necessarily. So being on chemotherapy is a good example, where your immune system is compromised while you're on chemotherapy. That puts you at a high risk even if the chemotherapy itself has nothing to do with the respiratory system.

05:37 Narrator: When the virus first began making its way around the globe, there were varying responses from individual nations. New Zealand is regarded as one of the biggest COVID success stories. With a population of 5 million people, they experience just 26 COVID-related deaths. To put that in perspective, Washtenaw County, the home of Ann Arbor and the University of Michigan, has had over 254 COVID deaths this past year out of a population of only 370,000. So are there any lessons we can take from New Zealand?

06:06 Eisenberg: New Zealand took this pandemic seriously, they took the science seriously, and they implemented thoughtful mitigation and intervention and control strategies, and that helped a lot. It also helps that it's an island and it's relatively self-contained, so they have maybe the luxury of being able to pull something off like they did. But you don't wanna discount the fact that a lot of these interventions become politicized, for whatever reason, and when that happens, you wind up with people that are not taking the science that seriously. They're valuing other aspects of independents or ability to choose, and making that a higher priority than the science and what we think is the best thing for communities to do. That being said, I do feel like one thing that we can learn from this is that the public health model of interventions, when we go into communities in different places in the world, I work in Ecuador, our role is not to go into these communities and tell them what we think is the right thing to do. That is more the medical model. If you come in as a patient to a doctor, you actually probably want the doctor to tell you what drug to take, and then you'll take that drug.

07:20 Eisenberg: And so the medical model is much more hierarchical, and there's a lot of confusion between the medical model and a public health model. Even within the medical community, a lot of times, a medical model is used and has been used in this pandemic, and I think that's problematic. I think that unless you fully engage with your communities, you gain the trust of the communities, and you actually work with the communities for the solution... So the solution doesn't have to be the best solution, from the scientific perspective. A solution that is not necessarily the best, but has everybody's buy-in and everybody does it is probably a more health-protective solution than a solution that the scientists think is the best, but they get a lot of resistance. I think we can learn from this that community engagement is really important, and we need to really think about how we build our public health infrastructure to bring that to the forefront of how we deal with these kinds of interventions, and not think that the medical model, which does work in certain contexts when you're dealing with individual patients, generally doesn't work when you're dealing with population-level problems and health issues.

08:30 Narrator: Over the last few months we’ve been hearing more about different variants of the virus that have been discovered around the world. So how worried should we be about these variants?

08:40 Eisenberg: It's something that we should be worried about because these variants are more transmissible and that could affect how the pandemic could take off in certain areas locally because of these variants. On the other hand, we shouldn't have been surprised and we weren't surprised that variants would be occurring. There's probably more variants than we have identified, 'cause this virus does mutate, just as any coronaviruses do, and so we would expect variants to occur. And if a virus is gonna mutate and sustain itself, it's the ones that are gonna be more transmissible that are the ones that we see. That being said, we also would expect that these variants would have lower mortality because a successful virus would be a virus that's very transmissible, for whatever reason, people are coughing more or they're releasing more viruses, but also the person that's moving around more and transmitting the virus, those strains are gonna be more successful. It's not to say that these variants are gonna be lower mortality because evolution takes a longer time to kind of equilibrate. But over time, we would expect successful variants would be ones that can transmit more efficiently, both because people are moving around more, that means they're less symptomatic, and also because they're releasing more virus.

09:57 Narrator: We’ll close with some of Dr. Eisenberg's biggest takeaways from this year and where he sees things going.

10:04 Eisenberg: Epidemiology is now a household term and people appreciate its value, hopefully. So I think, moving forward, I hope that's sustained more. One area that is becoming more of interest, that I'm working in, is wastewater surveillance, and we can see COVID in the wastewater, and if we see COVID in the wastewater, we know that COVID is being transmitted. That kind of surveillance, in a public health context, can really increase your ability to have an early warning system, that something's happening before it actually has taken huge public health tolls. If we think about when we first started actually acting upon this COVID pandemic, it was months and months before the trickling of cases that were occurring. And so we had this early warning, potentially, if we would have been able to be doing good surveillance. If you intervene before you're in this exponential increase of cases, you can be much more effective than waiting.

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11:04 Eisenberg: Post-9/11, there was a lot of investment in public health preparedness, and CDC funded lots of centers around the country. A lot of momentum. And that kind of fizzled over five or six years. So the hope is that that doesn't happen now. The hope is that we can value public health at the level that we value medical interventions. We spend so much more money on medical interventions, but study after study has shown, economically, the payoffs are public health interventions. The benefit of vaccines, given the dollar amounts that we spend to investment, is huge compared to the benefits of very expensive treatment for chronic diseases that don't necessarily give us that same payoff.

11:47 Eisenberg: It was probably the early 1980s when people were saying we're at the end of the infectious disease era. This was pre-HIV. I remember Deans of School of Public Health saying this, that we need to really shift our focus away from infectious pathogens and to chemical exposures and air pollution section. That was years before we wind up with the HIV pandemic, and then, subsequently, many more pandemics. The reality is that these pathogens are living creatures. They evolve to exploit different aspects of our society that they see is right for them to be able to propagate, and HIV is a great example of that. COVID is another great example of that, and I think that we should be expecting the unexpected, but I think the tools that we develop, the ability to develop a vaccine as quickly as we have shows promise that we can adapt to these different pathogens that do emerge.

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12:52 Narrator: This has been a special edition of Population Healthy, a podcast from the University of Michigan School of Public Health. During the ongoing coronavirus pandemic, we'll work to bring you analysis from our community of experts to help you understand what this public health crisis means for you. To stay up-to-date in-between special edition episodes, be sure to check out our website, publichealth.umich.edu. Subscribe to our Population Healthy newsletter at publichealth.umich.edu/news/newsletter, and follow us on Twitter, Instagram, and Facebook @umichsph.