On the eve of Halloween, Dr. Ashish Jha joins The Herald's COVID Pod team to discuss the implications of the Nov. 3 presidential election and how to safely exercise the right to vote. Dr. Jha also touches on the lockdowns occurring in multiple European countries and what that means for the United States. Finally, Dr. Jha helps make sense of case count numbers and discusses his predictions for what spring could look like.
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My name is Colleen Cronin, and I’m the Editor-in-Chief of The Brown Daily Herald, and I am talking to you today from Providence, Rhode Island. It is Friday, October 30; it’s snowing here on College Hill, although tomorrow is Halloween. This is our second episode of The COVID Pod, The Brown Daily Herald’s biweekly podcast about public health with Dr. Ashish Jha, the dean of the School of Public Health. We’ve already introduced you to Dr. Jha in our previous episode, and you’ve been introduced to Cate Ryan, a senior science and research editor and also the producer and sound engineer for this podcast — shout out to Cate. But Emilija and Rahma, tell us who you are and what you do for The Herald.
My name is Emilija Sagaityte, and I’m a science and research section editor for The Brown Daily Herald.
Hi, everyone. My name is Rahma Ibrahim, and I’m a science and research senior staff writer.
Emilija and Rahma are amazing — they do great coverage for the science and research section, and they’ve been really influential in getting this podcast going, writing questions. And they also do a Q&A with Dr. Jha on the weeks when we don’t do the podcast, so check that out on our website.
(In) today’s episode, in the lead up to the 2020 presidential election, we talk about the safety of early voting, what’s going on in Europe right now and also we got a little bit of a possible prediction of whether or not Brown could have double or triple Commencement in the future. Stay tuned to the very end to see what Dr. Jha’s prediction was — is — and if you have any questions, email us.
Before we get into sort of the more public health questions, we had two very important, quick other questions.
Okay. Yeah, I'm a little nervous. Public health stuff feels really comfortable but (I’m) a little worried about where you guys are going, but I'll do it.
Well, they might be controversial questions. First, we just want to ask you — from the last time we had you on the podcast, we asked if you had tried calamari — and we wanted to ask, did you end up trying coffee milk?
I did like coffee milk — I had it at Dave's (Coffee). And it's very good. It's a little sweet. So I felt that I was having dessert in the morning. But I actually really enjoyed it. And I think of it now, like, in the future (it) is going to be more of an afternoon drink for me. I don't think I want to start the morning with it. But in the future, and I have other places to try still.
Yeah, I think Dave's is a very good one to try though.
Do you have recommendations for other ones?
There used to be some in the Ratty that was pretty good. But alas, we haven't ventured there in a while. But when it opens up again, I will recommend that you head there and try theirs.
And then the other other question that we had that is very important is: Do you have a costume picked out for Halloween/Do you have any plans for this weekend?
What's been interesting is we have three kids, our oldest two are 15 and 13. … And then the third one is eight. A few years ago, everybody wore costumes. And in the last couple years, the 15 year old has become a little too cool for this. And the 13 year old is certainly interested in no input from us on what she's going to do. So my wife and I are both putting all of our attention on the eight year old who probably does not want as much attention as he's getting. Yeah, so I haven't personally dressed up in a while. But a lot of it is, like, just energy and making sure they do it.
Of course the other thing this year is everybody's trying to figure out how we make Halloween safe. So that's kind of a different interesting question. But no, Halloween is great. And I'm sorry, I don't have a more interesting answer, I don't have one myself.
That's okay, I think we're probably all going to just pick things out of our own closet to
hang out with our pod and celebrate. So then switching focus to public health, we’re
just sort of wondering what's been on your mind this week? What have you been following?
Ooh, it's been a pretty interesting week. One issue that certainly has come up over and over again is Europe, and what is happening in Europe and the fact that a bunch of European countries are heading towards lockdown. And everybody's asking, “Is this our future?” So should we maybe take a couple minutes to talk about that? Just because I think it's on the front of my mind.
And obviously, the other thing everybody's been thinking about this week is elections, and I'm happy to talk about elections in our country as well. But in terms of Europe, you know, they started seeing increases in cases in early to mid-August. And one of the things that keeps happening with this virus is people just don't take — when the virus starts kind of increasing in the community, we see this over and over again — people just don’t take it seriously for a long time. Because the numbers are increasing and people think linearly and the virus acts exponential, right. So if you get 100 cases one week, and then two weeks later, it's 200 cases, you're like, “Eh, it’s an additional hundred.” And then two weeks later, it is 400. And you're like, “Okay, it's 200.” People just don't recognize that what we're talking about is a doubling. And this is exponential growth. And at some point, you get to like thousands, and you're doubling, and that's where it gets really, really scary.
And essentially I think Europe ignored all the warning signs. And again, I understand Europe is not a country, so everybody's done it a little differently. Germany has been much much better, but even they are getting into trouble. But France, Spain and the UK essentially acted like the pandemic was over. The pandemic isn’t over.
It is a cautionary tale for us because for all of August and September and much of early October, these countries were saying, “We're never gonna lock down again. We're not doing this; that was in the past. We're not doing it, it was too painful.” And they're starting to do it. And no one locks down because you wake up one morning and say, “I really want to shut our economy down.” But you wake up one morning and you say, “My gosh, I’ve run out of every other option. I have nothing else left.” And that's when you do it.
And so the key lesson here is to not get there, (to) not find yourself in that position. And as a country, we're — I mean, again, our outbreaks are so different in different places. But some places are already there. I don't know how much longer they can avoid lockdowns. In other places — like I think about New England, Massachusetts, Rhode Island — we're probably a few weeks away from that.
And so if we don't do anything serious now, then in a few weeks, we're gonna find ourselves unable to continue, which is why I was heartened this week to hear Gov. (Gina) Raimondo both come out on Wednesday with some, I think, pretty tough talk. And then today, I think we're going to hear some policy actions. And that's going to be important. We can wait three weeks and then we will have no choice but to do a much more aggressive lockdown. And we don't want to do that.
I think that something that you just hit on a little bit that I wonder if you could maybe talk about as well, you know: In the United States, we just surpassed 9 million cases. Yesterday, we recorded 90,000 new infections, and those numbers are so huge. And I think you're talking about how people will see these increases as small. And then I think when they look at the big picture, they see huge numbers. And I think some people have trouble grasping them, and they get sort of numbers fatigue. And I'm curious, as a public health expert, how do you break those numbers down or present them so that people really understand them? And are there any sort of other numbers that you're thinking of that can sort of help people get the severity of what's going on?
So one thing I do try to do is in all of my kinds of communication, and I talk a little bit about national numbers, but mostly I try to keep all the conversations about numbers at the state level, because people have a better feel for what their state size is. And so if Massachusetts is recording 1,000 new cases a day, people in Massachusetts have a sense of what that means.
There are two problems with the national number. One is it gets very big and people can't really quite understand what 90,000 is. But also nobody lives in America. People live in Massachusetts, they live in Rhode Island … And so if I told you there's a really horrible outbreak happening in North Dakota, which it is, you'd say, “Well, that's terrible. But I don't know that that changes my personal behavior.” But if I told you the really bad outbreak (was) happening in Massachusetts, that might change your behavior, right? So one is to contextualize it kind of more locally.
But the second thing is to talk about things that also people can relate to, because we do know that a chunk of people who get infected do fine. But what people really do care about and feel much more is when they start seeing hospitalizations going up. And so when you realize there are more and more people in hospitals today than there were two weeks ago. And nationally, hospitalizations are up about 20 percent over the last two weeks, about 30 to 40 percent over the last month. And hospitalizations, because they're a late indicator, are going to continue rising, at least for the next month. And once you know that you’ve baked in a month of increasing hospitalizations … that's something people relate to, obviously. Deaths, also, people relate to, but hospitalizations and deaths feel much more substantive to people than the number of infections.
The hardest part is that there are a group of people really led in some ways now by the White House's chief health adviser, Scott Atlas, who (is) trying to convince people that these two things are not related, that there's no relationship between how many people are infected and how many people get hospitalized and die. And it just flies in the face of all the data and all sort of logic as well, that as more people get infected, not everybody is going to get hospitalized, but over time, more people will get hospitalized and more people will die. And so it's almost a: “Hey, don't pay any attention to infections because they don't matter.” But they do matter because they're a harbinger of bad things to come.
On that note of contextualizing the cases locally: So we spoke last week … about the numbers in Rhode Island increasing (in the week before). And with that, we've also seen the numbers (at) Brown increasing. And so we were wondering if the state's coronavirus situation could be bleeding into the Brown bubble? And if so, how is that happening?
In my mind, it would be almost impossible for it to not bleed in a little bit. So let's talk about how that would happen. You know, Brown is not a bubble, right? And the students are not a bubble and the faculty and staff are not a bubble. And you can start with faculty and staff, which are easiest to see. They go to grocery stores on weekends. They go, they see their friends who are not members of the Brown community. They do all of these things that get them interacting with the community.
In normal times, we see that as a good thing; we want people to be deeply embedded in the community. We don't want a Brown bubble. And you can imagine the student version of that. Some students may stay on campus and never leave campus and really stay tied in their pod. But there are a lot of people living off campus. Those people living off campus might go to a restaurant, might go interact with friends who again, might have graduated from Brown. You can imagine all the interactions that we all have in our lives that are not linked to Brown. And so it has always been true that our ability to do anything is deeply tied to what is happening in Providence, Rhode Island, more generally.
So as we see, cases increasing in Rhode Island, infections increasing in Rhode Island, it has always been my expectation that we will see more infections on our campus. And we are seeing that, and I am — you can't see me, but I'm actually literally reaching out and touching wood here …
My hope is that two things happen. One is, from a policy point of view, we can manage infections in the community. And it's not just policy. It's also individual behavior, but it certainly is also policy. And so I want to see more action from the governor, which I think is coming. And then we've got to also keep working on protecting the Brown community. And so if we can do work on both ends, I think we can get through the next four, six weeks. But the fate of both are intrinsically tied to each other.
And then on a sort of separate note, you mentioned the election earlier. And we were sort of wondering if you could, I guess, reflect on how voting has been going so far in terms of COVID? Because we know early voting is already taking place. And then next week, people are going to be heading to the polls on Tuesday. So, do you think that that will impact the coronavirus curve? And what precautions are happening at voting centers across America?
There (are) so many complex issues here. I mean, one is: Obviously the safest way to vote is to vote by mail — you don't have to leave your home — for a variety of reasons. And again, much of it (is) baffling to me. We've made voting by mail this incredibly complicated political thing. And it's unfortunate, because in the ideal world, that's what you would do. But fine. We are where we are on voting by mail.
So let's think about voting in person. So I voted last Saturday in person — early voting. And it was fine. It was totally safe. I had to wait outside for maybe 20 minutes and so I was very lucky. And it was a pretty painless experience. But as I'm watching data come in and talking to people — I mean, obviously the biggest issue in my mind is a lot of people are having to have long waits. They're having to stand outside for four, six, eight hours. We can have a different conversation at some point about the state of our democracy and why we make voting so difficult. Staying focused on the coronavirus, waiting in long lines obviously is uncomfortable, but it's not dangerous. Again, you should be wearing a mask and people — generally when you look at the photos — are reasonably distanced. And you're outside, like, it's really safe.
So the only risk period, in my mind, is when you're indoors — when you go inside into the polling booth. So we typically tend to think of risk with this virus as exposure for at least 15 minutes. So if you go in and spend 5-10 minutes, it's just much, much less likely you're gonna pick up the virus. People rarely pick up the virus in a couple of minutes. But most places I've seen, the poll workers are all wearing a mask. Again, you should continue with your mask when you go indoors. There's a reasonable amount of distancing. You know, there's all this stuff about, “Should people bring their own pen?” Like, if you want to bring your own pen then you can, but in general, don't bother bringing a pen because you may have the wrong color — just use the pen they're gonna give you.
So again, this sort of obsession with fomite transmission that I'm going to pick up (COVID-19) by touching a pen. I have not seen any cases of anybody picking (COVID-19) up (through that mechanism). Like, again, if you see a pen, don't pick it up and lick it. Don't do weird things. Bring some hand sanitizer, but most places also have (hand sanitizers).
All of this is my way of saying, if you act like a normal person and you go in — and especially if you are concerned: Do your homework beforehand, look at a sample ballot, know who you're going to vote for. If there's a bunch of ballot questions, read them beforehand, so you're not trying to think about, “Do I support this or do I not?” Like, make your decisions, go in, vote and leave. It'll take you five or 10 minutes at the most. And it'll be very, very safe.
So I really believe that in-person voting is extremely safe. It is probably safer than going to a grocery store. And if you're somebody who feels uncomfortable going to a grocery store for five minutes, then I understand. But from a safety point of view, I am unworried that voting is going to lead to any spikes. Just not worried about it at all. I don't think so. That's why I've been telling people, like, you should vote and you should not let coronavirus slow you down in terms of voting. Vote early if you can, but if you can't, show up and vote on Election Day.
I think one thing that some of us are thinking about is … the aftermath of whatever comes on Tuesday, whether or not we even have an answer Tuesday night or Wednesday, or later than that. I think people expect that there could be a lot of protests and a lot of large gatherings. Things are getting a little bit colder so maybe some of those gatherings would be shifting inside. But I'm curious what you think about that — if you're worried about that. And if you have any tips for people … if they do feel the need to go out there and voice their opinions after the election.
Yeah, to be perfectly honest, I am worried about that. I am worried about how the election is going to go. I'm hoping for a decisive answer — maybe not on Tuesday night, but in the day or two that follows. But certainly if people feel like the election process has not been legitimate, then you're going to see large amounts of, I think, protests and people expressing frustration and anger. And I think they have a right to — that is literally a key part of democracy is the ability of people to express themselves.
Much of the evidence so far, when I think about the Black Lives Matter protests, for instance, over the summer … is that protests have not led to large outbreaks. I have to tell you, I've been surprised. So when the protests were happening, you know, (I) probably actually wrote a bunch of Twitter threads and others where I said, “I'm worried that this is going to cause more cases.”
And I understand we're weighing a set of issues here. And people feel genuinely and legitimately angry about systemic racism in our country. And I understand and support people's desire to speak out against it. But we're still in a pandemic, and the virus doesn't care. And I said, I was worried. And then probably about a month or six weeks later, (I) wrote a piece in which we really tried going through all the protests, where they occurred, the size, and tried to look for increases in infections following it. Didn't see it, couldn't see it at all. So it turned out that I was worried — and, I mean, I don't know if I shouldn't have been. But it turned out that my worries turned out wrong. It wasn't that bad.
So all of that is to say, if we can keep protests outside, if people can wear masks — protests are inherently hard to do (with) social distancing, but to the extent the people can. Or if you're in a little pod, if you can stay in that pod, largely, all of that would be super duper helpful. I do worry about people (going) indoors, and that stuff is going to get risky. So again, my hope is that we just have a clean election, we have a clean result, people feel like it's legitimate and we can move forward.
But if not, I don't think there's any telling people, “Don't do this, don't protest.” I think people are gonna want to express themselves and, like I said, I'm very supportive of that. I think we're all going to have to think about — how do we not then also put people's lives and health at risk?
The last time we spoke on the podcast, you sort of left us with, I think, what a lot of people felt was a really hopeful note about possibly emerging into some sort of sense of normalcy in what could be a couple months or, you know, when we get a vaccine or a good therapeutic. And I'm curious if there is one piece of good news that you've seen this week, that really stands out to you as something hopeful that people can think about … as we’re in sort of a turbulent political time as well.
So I think as a general rule, all of what I'm hearing around vaccines and therapeutic timelines are continuing to move forward in the right direction. Again, sometimes the absence of bad news is the good news. So I remain optimistic that we'll have a vaccine or two, authorized this year and more widely available early next year.
You know, in the public health community, there are many different voices and obviously, we don't all agree with each other. We don't all confer with each other. We do talk, obviously. But I think this week, you saw a real convergence of public health experts from across the political spectrum, from someone like Scott Gottlieb, who's been terrific, super thoughtful. He was the first (Food and Drug Administration) Commissioner for President Trump. Like, he's not a liberal Democrat … and he came out and said we need a national mask mandate. And Tony Fauci who's been hesitant to say that came out and said we need one. And you saw real convergence among experts from a variety of political backgrounds saying we've got to take action, and here are certain things that need to happen.
We are, unfortunately, in a situation where when you get that kind of convergence, you tend to get political leaders to respond because they think, “Wow, it's really hard to argue this is partisan.” Right now, because of the election cycle and because of our political leadership in Washington, there just hasn't been the kind of response that I was hoping. But it gave me hope that, at least in the public health and the health care community, people could put aside their political differences and all kind of try to rally around a national strategy. The hard part will be whether we can get that implemented or not.
Look, I think the key kind of bottom line is, there's no easy way out of the next 6-12 weeks, right? So basically, November, December, January are just going to be hard months. They may be easier if we are smart now. They will be harder if we wait. But that's a time frame that, I think, people just need to understand that we need to hunker down at this point.
One of the huge problems of this administration has been they keep saying things like, “This is going to go away (now) that we're rounding the corner.” What that does is it tells people that they can let their guard down, that they don't have to make investments (in) getting through a time period. And I think it's been incredibly harmful.
And so the message I want to leave people with is there's nothing about the next few months that is going to be easy and fun. And we're not getting through this without some amount of difficulty. But if you can find a strategy to get yourself through the next 2-3 months, it'll get better. And it'll get better.
And like, I don't focus on getting better in January or February, but it will start getting better somewhere in that time frame, I think, because we will have a vaccine. I think we'll have a lot of vaccines out — not like (a) broad population, but health care workers — I think, we’ll have a ton more testing available. And I'm hopeful that by January, February, we will be in a better place than we are now and the spring semester at Brown will feel more comfortable.
It'll still be hard. Like, again, I don't want to make it look like it will be back to normal. But I'd rather be on the trajectory towards things getting better than things getting worse. And right now, we're in a little bit of a period where things are going to get a little worse before they get there.
Thank you so much. I think us seniors are hoping that maybe next semester will be normal enough that we will get a Commencement and there won't be a triple Commencement in 2022 at Brown.
So that's an interesting question: whether you'll be able to have a Commencement inMay, mid-May, late May — is that about when it is? I'm going to go (out) on a limb — I shouldn't — but I will and say I think you'll have Commencement in late May. And you know, it may be a little modified, it may not be totally normal. And you may need to do more things outdoors and there may be fewer indoor stuff. And people will have to wear masks. But the question will be, like, can your family travel to Providence, that kind of stuff. I think there's a better than even chance that we'll be able to do it in May. Let's keep our fingers crossed and work towards it.
Thank you so, so much. Stay safe, stay warm out there with the snow in Providence. And we just appreciate having you talk to us. It's always — we always learn something new. So thank you.
Oh, it’s so much fun. Thank you and think about other coffee milk suggestions, which I'm happy to try. And, oh, let me just add one more thing: I tried my first PVDonuts. They're pretty good, pretty good.
But the problem was, it was going to be a little donut — I don't wanna call it a “donut derby.” (It) was gonna be Knead (Doughnuts) versus PVDonuts, and I was doing it on Wednesday. An undergrad and (Master of Public Health) student had set this up. But we found out that Knead is closed on Wednesdays. And so we could only do PVDonuts. So next time, I'm going to do a true taste test. And maybe we can talk about it in one of the future podcasts.
We would love that. Although that is definitely a controversial topic that the BDH tries not to weigh into.
I understand — like you guys are willing to push the boundaries on tough stuff, but there's some topics are just maybe too... Are you willing to weigh in at this point on your personal choices? Or do you feel like that would be too polarizing in this moment in our country?
I think it's too polarizing, I have to say.
I appreciate that. I get it. All right. All of you: Stay away, stay safe. And I look forward to being back in touch.
This podcast was produced by The Brown Daily Herald. The music was created and composed by Katherine Beggs, a Brown University undergraduate student.
Produced by: Cate Ryan and Colleen Cronin
Reporting contributed by: Emilija Sagaityte and Rahma Ibrahim
Sound engineering by: Cate Ryan
Music composed by: Katherine Beggs '22
Special thanks to Elise Ryan and Bilal Ismail Ahmed for cover design and production assistance.