Public health in action: Five years after COVID-19

0:00:02 Host: On March 20, 2020, as the world was in its first week of seemingly grinding to a halt, we published the first of our series of podcast episodes about the unfolding COVID-19 pandemic. We'd go on to produce about 40 podcast episodes chronicling public health insights over the next six months. Now, five years later, we're looking back and here's how that first episode opens.

0:00:26 (past clip of HOST): Chances are, your past week has gone something like this, you've had a social gathering you were looking forward to attending, cancelled. You've stood in line to stock up on groceries. You've laughed at a meme about people hoarding toilet paper. You've heard about flattening the curve, and you've worried that you or someone you love will be diagnosed with coronavirus. You've also probably heard someone say, or you've said it yourself, that you've never seen anything like this response to coronavirus. The quarantines, the cancellations, the constant media coverage. And you've probably wondered, is this all necessary?

0:01:01 Host: Hello and welcome to Population Healthy, a podcast from the University of Michigan School of Public Health. Join us as we dig into important health topics, stuff that affects the health of all of us at a population level, from the microscopic to the macroeconomic, the social to the environmental. From cities to neighborhoods, states to countries and around the world.

0:01:32 Host: Five years ago, our world changed dramatically as COVID-19 was declared a national emergency in the United States. Reflecting on these past five years likely brings a range of emotions because although we all experienced the pandemic, it seems no two individuals had the same experience. Collectively during the pandemic and since then, we have witnessed incredible depths of fortitude from individuals and communities, and it's reasonable to say everything has changed. This episode of Population Healthy will not attempt to cover everything, but we wanted to share a few stories from our public health community to reflect on lessons learned and how these insights apply to work currently underway. Join us as we look back, beginning with some voices from the earliest days of the pandemic.

0:02:22 Lindsay Kobayashi: I think about the COVID-19 pandemic in terms of the public health effect, like an onion. The outside layer of the onion is the one that we are all really looking at right now, and that's COVID-related mortality and morbidity. And that is extremely urgent and concerning and demands immediate attention.

0:02:41 Arnold Monto: We've all heard about Operation Warp Speed. This sounds kind of strange and suggests that there's undue speed associated with the development and in fact that's not the case.

0:02:54 (clip from "All about Coronavirus: A video for kids and their families"): Coronavirus is a word people are talking about a lot lately. The Coronavirus is a kind of germ that is making people sick all over the world.

0:03:03 Fareed Zakaria (clip from CNN): Joining me now is Holly Jarman from the University of Michigan School of Public Health.

0:03:07 Holly Jarman: I think there's a couple of reasons behind what we see here in terms of the very different experiences between the US And European countries when it comes to the first wave of COVID-19.

0:03:18 Jon Zelner: When we talk about social distancing, one of the things that I think is just really important to remember is that not everybody has the choice, right? And we've devolved all these things down to personal behavior, like you should stay six feet away, you know, you should not sneeze on the cucumbers and all of these things. I think, you know, we would be wiser to think about the reasons that people can or can't do these things or do or do not listen to these messages.

0:03:46 Rick Neitzel: So the key here is flexibility and creativity and innovation. Again, there's no one-size-fits-all approach here. And every different kind of workplace is going to have to consider different factors. But the good news is we've got a lot of creative and innovative people working on these solutions, both on the academic side, but also in industry, to make sure that when our businesses reopen, they're protecting the workers.

0:04:09 Sharon Kardia: For particularly vulnerable populations, so you can imagine people that are older than 70 living alone, and they don't really actually have enough support as it is in many cases to navigate a significant illness. But a pandemic is going to be very difficult. How are they going to actually be able to get the news, get social contact, and get the healthcare that they need, especially if they're, for instance, in a rural setting where there's a long distance to go and there may not be a lot of people that are actually checking in on those individuals.

0:04:47 Host: Mary Janevic is a research associate professor in the Department of Health Behavior and Health Equity at the University of Michigan School of Public Health. Her work centers on promoting healthy aging, particularly in underserved populations. We recently spoke with her about some of her experiences and lessons learned during the pandemic.

0:05:03 Mary Janevic: In March 2020, we had just launched a pilot trial in Detroit of a new intervention led by community health workers that taught older adults skills for managing chronic pain without medication. We called the program Positive Steps, and it combined pain self management skills training with activities based on positive psychology that are intended to boost positive emotions. Our community health workers had telephone sessions with participants each week, and during each session, they would help participants make a plan to engage in structured, simple, enjoyable activities over the upcoming week. So these we call them positive activities, and they're things like savoring everyday moments or doing small kind things for others, or writing down one or two things that you're grateful for each day and putting the little slips of paper in a jar so that you can go back to look at them later. The positive emotions that people experience when they do these types of activities, besides just being nice things to feel, have also been shown to broaden people's thinking and increase their motivation. And this makes people more likely to try new skills related to managing their health. Also, over time, getting these regular little spikes of positive affect can help build emotional resilience.

0:06:19 MJ: And of course, especially in the early days, Detroit was extremely hard hit by COVID, with cases and mortality rates that were far higher than the rest of the state. So it was also a time of grieving in the community. It was a time without a lot of positivity. So it could be helpful to be intentional about trying to create opportunities for small, positive moments when so much was outside of anyone's control. And what ended up happening is after we finished the Positive Steps pilot, which was focused on chronic pain, our findings suggested that it also had a positive impact on physical and psychosocial functioning more generally. And by that point, months into the pandemic, the lack of activity and isolation were really beginning to take their toll on older adults. One thing to understand is that the old saying use it or lose it is really true when it comes to functioning among older adults, whether it's physical functioning or cognitive functioning. Use it or lose it. And because the pandemic prevented older adults from doing their usual activities, from using it, it was really placing them at high risk for premature loss of function. So this was where we got the idea to develop a new version of Positive Steps.

0:07:29 MJ: We called this new program RESET, that stands for Re-Engaging in Self-Care and Enjoying Today. We were fortunate to receive NIH funding and are now several years into testing RESET in a large randomized trial in collaboration with the Detroit Health Department. Another thing I love to hear is when participants tell us about how they've shared things from the RESET program with their friends and family so that other community members can benefit from the information as well. We have a podcast series that goes along with RESET. It'[email protected] if anyone would like to listen to them. And in this series, we talk to a number of academic experts and community members about what older adults can do to stay healthy and engaged in life. We've heard lots of stories from participants about how they were impacted by the programs. One of our participants tells a story on the podcast about her experience with the Gratitude Jar and how once she started using it, she realized that one jar wasn't enough.

0:08:24 (clip from RESET podcast): You know you need bigger jars, don't you? Yes, I need bigger jars because sometimes what I have to do, you know, you smash them down. Yes. Oh, this one is, it was written November 19th of last year and it says, I am grateful that the Lord let me see another birthday. 75 years old. Thank you God. Thank you.

0:08:54 MJ: Many older adults learned new tech skills during the pandemic, especially using FaceTime and Zoom so that they could communicate with family members, attend virtual church services, have virtual medical appointments, and that kind of thing. And this really opened up a lot of options for them that they continue to use today. So some older adults who previously had no particular interest in learning some of the new communication technologies are now huge fans. We heard a lot from our study participants about ways that they coped. One of my favorite stories is about a woman in her 70s who told us that she used to sneak into the fitness room of her senior housing facility late at night to ride the stationary bike because the fitness room was officially closed. So she was doing these illicit workouts at 10:00 at night when no one was around to see her because that's what she needed for her wellbeing. So that's a great example of resilience and dedication. In general, the idea of delivering health promotion programs remotely to older adults has become standard, whereas before the pandemic there was still a widespread feeling that many older adults didn't want anything to do with tech.

0:09:57 MJ: Although we still don't know what we'll learn about the effect of RESET on physical and psychosocial functioning, we do know that the Detroit Health Department is already thinking about how they can continue to offer RESET even after the study's over because they've gotten overwhelmingly positive feedback from participants about how it's helped them get back on track and feel better. And the Detroit Health Department recognizes the need for programming that supports the wellbeing of older adults, especially in this post-pandemic era.

0:10:32 HOST: Nancy Fleischer is an associate professor of epidemiology and co-director of the Center for Social Epidemiology and Population Health at the University of Michigan School of Public Health. She's the principal investigator of the Michigan COVID-19 Recovery Surveillance Study, or MI-CReSS, a collaboration between the University of Michigan and the Michigan Department of Health and Human Services to understand the experiences of Michiganders diagnosed with COVID-19.

0:10:57 Nancy Fleischer: I don't think that there was ever one singular moment when I realized that the pandemic would fundamentally change my work. The shutdown certainly made us all realize that this was a new situation that we had no frame of reference for in our lifetimes for most of us. But even at the beginning of the shutdown, the extent to which the COVID-19 pandemic would alter our lives for the next several years was hard to imagine. But it was during that spring of 2020, in April, when we started the Michigan COVID-19 Recovery Surveillance Study, which we refer to lovingly as MI-CReSS. I am a social epidemiologist, not an infectious disease epidemiologist, but my team and myself were looking for ways that we could use our epidemiology skills to support the public health response to the pandemic. So when our department chair at the time, Joe Eisenberg, brought to a faculty meeting that the Michigan Department of Health and Human Services was looking for support to set up surveillance of COVID-19 recovery, I volunteered. My team and I quickly developed a questionnaire, put in place a data use agreement with the state health department, recruited students to work as interviewers, and set up and launched a flexible surveillance study within about two months.

0:12:05 NF: At that time, I thought it would be a summer project to support the state health department. But five years later, we are still collecting data and gaining insights into the long-term impacts of the pandemic on people in Michigan.

0:12:17 NF: From the beginning, MI-CReSS was designed to understand both the ongoing health consequences of COVID-19 illness, but also the social impacts of the pandemic. So we surveyed people who had been diagnosed with COVID-19 in Michigan. And one of the most important contributions of MI-CReSS has been to identify and describe long COVID. So when people started reporting in the media that they were not recovering from COVID-19 and that they had ongoing symptoms that were sometimes very debilitating, we knew that we could identify that in our data. So in early 2021, we published of the first studies that used a population-based sample instead of a hospital-based sample to describe the extent of the impact of acute COVID-19 illness on long-term symptoms. And since then, we've produced other papers and reports that give us additional insight. So, for example, we have a paper under review right now that shows that having persistent symptoms for 90 days or more after illness is associated with higher prevalence of disability, including cognition disability and mobility disability.

0:13:21 NF: And that's nearly two years after their initial illness. Importantly, we've also shown that people can reduce their risk of developing long COVID through vaccination because vaccination helps reduce the chance that people get sick in the first place and also the severity of acute COVID-19 illness if they do get sick. The burden of long COVID has been quite astounding. So very early in the pandemic we had more than 20% of the people in our sample that identified as having symptoms that lasted more than 90 days, and for some people, those symptoms are lasting years. So we're continuing to learn through our surveillance at communities have not fully recovered from the pandemic. So the COVID-19 pandemic affected people's health, their access to care, their ability to work, and social connections. As a society, it's important that we recognize that some of these consequences of the pandemic are due to long-standing problems that we have in our healthcare system and the way that our society is structured. We need to work to provide universal healthcare so people can access care in normal times as well as in times of crisis. And we need to provide the social and economic resources so people don't disproportionately suffer during future health challenges based on the type of job they have or which part of the state or country they live in, or their social circumstances.

0:14:43 HOST: The COVID-19 pandemic caught the world off guard, compelling us to move swiftly and navigate uncharted waters. It was a stark reminder of how interconnected our world is and how crucial immediate, coordinated responses are in the face of global health challenges. Now more than ever, we understand the critical role public health plays in our society. Whether it's through ongoing research like the MI-CReSS study, programs like RESET that empower individuals, or infectious disease monitoring and response, coordinated public health efforts prepare us all for the next crisis.

0:15:23 HOST: Thanks for listening to this episode of Population Healthy from the University of Michigan School of Public Health. We're glad you decided to join us and hope you learned something that will help you improve your own health or make the world a healthier place. If you enjoyed the show, please subscribe or follow this podcast on iTunes, Apple Podcasts, Google Play, Stitcher, Spotify, or wherever you listen to podcasts. Be sure to follow UMICHSPH on Twitter, Instagram and Facebook so you can share your perspectives on the issues we discuss, learn more from Michigan public health experts and share episodes of the podcast with your friends on social social media.

0:15:53 HOST: You're invited to subscribe to our weekly newsletter to get the latest research, news and analysis from the University of Michigan School of Public Health, visit publichealth.umich.edu/news/newsletter to sign up. You can also check out the show notes on our website, population-healthy.com for more resources on the topics discussed in this episode. We hope you can join us for our next edition where we'll dig in further to public health topics that affect all of us at a population level.