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Dean Jha: ‘It's really critical that we take a moment and just reflect’

Rhode Island releases vaccination plan, COVID-19 positive cases rise

Dean of the School of Public Health Ashish Jha spoke with The Herald Oct. 23 to reflect on the state of the COVID-19 pandemic over the past week. He spoke to climbing case numbers and related current events in Rhode Island, including Rhode Island’s release of vaccination plans Oct. 16 and the external review underway at Roger Williams University in response to a contained cohort of positive tests within one of its research buildings housing a lab focusing on COVID-19, according to WPRI.

Herald: How significant is the recent rise in cases in Rhode Island, and why do you think we're seeing this rise?

Jha: I think it's pretty significant … obviously we're seeing substantial increases across much of the country, so it's not a Rhode Island alone phenomenon — more than 40 states are seeing large increases. ...

I do think that some of the big outbreaks that we're seeing got set off by Labor Day weekend, just because of the way you can look at the national pattern. But what happens is, once these things get momentum, they start feeding on themselves. … It becomes self sustaining. So yes, you can say the initial impetus was that holiday weekend, but then you've had many, many weeks to try to act on it. ...

When people gather indoors, they're not wearing masks and there isn't great ventilation. That's the context in which the virus spreads. Nationally, we know indoor dining (and) bars are major sources of spread. And then indoor gatherings. People have this kind of mental image of their home as a sanctuary, and they're getting people together. … There's national data that colleges have triggered large outbreaks. But I'll be very clear about this: Colleges that have triggered large outbreaks have had no testing, no real plan on keeping students and faculty isolated and safe. 

In the news this week, there were reports that Roger Williams University had an outbreak where they were doing their research. Could you speak to what some potential causes could be that led to that lab-based outbreak?

There's a lot we don't know. So, we know that a lot of individuals who worked in this lab all tested positive. And then we heard from (Roger Williams) University that they were handling material that could trigger a false positive (a positive test result for someone who is not actually infected), and that was a part of the concern. And then a large chunk of the people got retested and came out negative. And that, to me, suggests they probably were false positive tests. 

But it brings up a broader question, which is, are laboratories dangerous? Are they dangerous places for these viruses? And the short answer is not really. … The safeguards for working with dangerous viruses are really quite robust. I'm not saying it never happens, of course, it can happen. But it's pretty rare that you get outbreaks from laboratories just because we have spent so much time and resources in our country really building up safeguards. … If we discover that somehow Roger Williams wasn't following those safeguards, or something went wrong, then we can revisit this, but everything I've seen so far suggests that it probably wasn't a breach of any of the kind of protocols for keeping people safe.

Recently, Rhode Island released a COVID-19 vaccination plan. What do you think about the effect of the state having drafted that plan earlier, even before a vaccine is out? 

There are two important parts about the vaccine. One is you have to develop one, which is hard enough, and the science is hard. And then the second is you have to have a plan where people are going to feel confidence in the vaccine. They're both really, really important. 

We are at a point where the science of vaccine development has gone very well. It's been done with a lot of integrity, and we're very close. There are four vaccines right now in late stage trials. And I suspect — expect — that probably two of them will get preliminary authorization over the next month or six weeks. I don't know exactly, … but the point is at least two of them are clicking along in a way. And then two more may follow after that. But then there's a whole host of other vaccines that are coming down the pipe. ...

So then the question is, how do you build confidence? The truth is that we have seen politicization, we've seen President (Trump) talk about timelines for the vaccine, talk about how it's his vaccine. It's not anybody's vaccine, it's the scientific community's vaccines, the American people and the people of the world actually, their vaccine. So that politicization has been harmful. ...

(Rhode Island leaders have) got to come up with a plan locally. And what you want to do is you want to engage local, clinical and public health leaders, and lay out an approach that people are going to look at and say, yeah, that feels really reasonable and comfortable. And that's what they're doing. And they have a committee of a lot of people who inspire confidence in the greater Providence and the Rhode Island community. 

I think that the distribution plan ... is going to evolve as these things usually do, but I think it's a really good idea for every state to develop such a plan. 

How do you see schools like Brown being a part of that process of distributing vaccines? We know that there's also a ranking of who gets the vaccines first usually, so where do you think students come in, as well, in that rank?

I haven't seen yet a national plan on priorities for distribution. There are a couple of approaches that are reasonable. One is, there's broad consensus that healthcare workers and first responders should be in the first group, and I think that's right. But the second group is interesting. 

It's very logical to believe (that) high risk individuals should go next, elderly people, people with chronic disease, people who are in nursing homes and other congregate settings, care settings. That makes total sense. There is an argument to be made that actually young people may be better in that second group after health care workers, probably because the immunologic response in young people is going to be more robust from the vaccine, and young people are driving a lot of the infections that eventually are spilling into older people. So if you can actually cut it off among young people, you'd actually be able to do a better job protecting everybody. 

I haven't seen the plan, (but) the National Academies of (Sciences, Engineering and) Medicine put out a plan … suggested elderly and vulnerable people second. Let's see what we come up with as a nation. … What colleges and universities will do will really depend first on what the national and the local plan is. …

Assuming it all goes well, I'm going to push pretty hard for people to get vaccinated because it'll make a huge difference in terms of building safety into our community and making it a safer place for people to get together and go to school. But I think ultimately, that's going to have to be driven by how safe and effective the vaccine is. But I expect Brown to play a very active role in helping get the vaccine out to its community.

Any final thoughts or messages to the Brown community?

What's really remarkable is how well the community at Brown continues to do with COVID-19. And we are seeing these large increases across Rhode Island, and yet the numbers (at) Brown continue to look very good. And they continue to look good, not just because testing is a really important part of keeping people safe, they look good because people are being careful, people are being thoughtful and people understand that we're in a very difficult situation nationally.

And we all know that is not happening everywhere in America. I think it's really critical that we take a moment and just reflect on that. I want to say to the Brown community, to our community, thank you for being vigilant and thoughtful and careful in this moment, because it not (only) keeps our communities safe, but it also makes sure that we're not contributing to broader spread in the Providence and Rhode Island communities. And it's really remarkable because again, I look at the numbers every day from the Brown COVID-19 dashboard, and so far, knock on wood, we're doing great. And we just got to keep going. So I just think we should acknowledge when people are doing a good job.

This interview has been edited for length and clarity.

-Additional reporting contributed by Emilija Sagaityte


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