On this bonus episode of The COVID Pod with Dr. Ashish Jha, Dean of the School of Public Health at Brown University, Dr. Jha provides advice for managing COVID-19 over Thanksgiving. The COVID Pod team breaks down what students who must travel away from campus for the upcoming holidays, remote finals period and break should do to protect themselves and their families. Jha also reflects on updates in the vaccine development process and his Nov. 19 testimony in front of the Senate Homeland Committee.
Subscribe to the podcast on Spotify, Apple Podcasts or listen via the RSS feed and email us to contribute a question for the next episode: email@example.com.
It's Friday, November 20. And this is the COVID pod with Dr. Ashish Jha. My name is Colleen Cronin. I'm editor in chief of the Brown Daily Herald. And I'm here with my colleagues from the science and research desk who will introduce themselves to get started on today's episode.
Hi, I'm Cate Ryan, and I'm a senior science and research editor at the Herald.
And I'm Rahma Ibrahim, and I'm a science and research senior staff writer.
On today's bonus episode, Dr. Jha, who's a public health expert and Dean of the School of Public Health, will talk about what students should consider when deciding if they want to go home for Thanksgiving over the upcoming break, and what precautions they could take if they're deciding to go home. Dr. Jha also talks about some new developments with COVID-19 vaccines. And it's a great episode. So listen in. And if you have any questions, let us know.
Before we dive into our questions about Thanksgiving and the holidays, we wanted to ask if you could sort of reflect on the experience of testifying yesterday in front of the Senate Homeland Committee on hydroxychloroquine.
Sure, absolutely. So, you know, I've testified in front of Congress a lot in the past, and certainly, during this pandemic, that’s probably maybe close to a half a dozen times. Um, this one was very unusual.
And it was unusual, because, like, obviously, we have a lot of very complex pressing issues facing us, in the pandemic, whether to use hydroxychloroquine is not one of them. There has now been just so much work so much data, that shows that it really just doesn't make much of a difference. And while this might have been an interesting conversation in April, or May, when the evidence was still out, at this point, it's really hard to understand why this happened.
And the funny part about it was the other times I have testified, like, you know, I know the other experts, sometimes we disagree on things. But we begin with the same book of facts. And then we tend to disagree on analysis. In this, like, we didn't even begin with the same book of facts, like the other experts, had these very strongly held beliefs largely based on anecdotes. You know, I would say things like, well, in a randomized trial, like didn't show any impact. And they said, Well, I've taken care of 100 people, and I've given it to them, and they all did well. And what it was, in my mind … it wasn't about hydroxychloroquine, though, I do think part of the motivation was we are going into a such a bad time of the pandemic. And people are always looking for silver bullets. And so this was a silver bullet that had been debunked, but now was trying to sort of being brought back up. But there was a broader point. And the broader point was, how do we know what we know? How do we generate knowledge? And who are the arbiters of knowledge? And in some ways, this hearing felt like an attack on... a very kind of clear one on the scientific process, as though kind of modern medicine, you know, practices it, right.
Like one of their witnesses kept basically saying randomised trials are unnecessary now. And I thought, … the reason we're so successful, so much more successful with medicine than we were a generation ago, is because we moved to randomised trials, like we actually have figured out how to learn new stuff. And these people really wanted to go backwards and talk much more about personal experience and observational data. It was very bizarre, and I felt like I needed to be a part of it to sort of push back. But that's not the conversation I wanted to be having yesterday.
Talking about sort of looking at the science of things — I got a news alert this morning that Pfizer might be seeking emergency authorization today. And I was wondering if you could talk about that a little bit and what that actually means?
Yep. Yeah, so there are two parts of it that are worth understanding. So first of all, not surprising. We were expecting something today or Monday. In general, with the Food and Drug Administration, there is full approval that you can go for where you have a complete set of data on a clinical trial. You go to the FDA, and they evaluate it, and they give you a thumbs up or thumbs down. Or in the setting of an emergency, you can ask for what's called an emergency use authorization. And the bar for an EUA is lower.
But the idea is, and actually I talked about this yesterday in my... in the hearing, the bar is lower, but it's not zero. You still have to have a reasonable amount of evidence, you still have to show that there's more harm than good. And you have to commit to collecting more data. So they can go back and reevaluate the EUA to see if you need if you should get full approval or not. And I actually think you know, I've been a little bit skeptical about the EUA process for vaccines. But as I have sort of seen data coming in, I think at this point, given how bad the pandemic is, it's not at all unreasonable to to authorize an emergency use of this vaccine. And it's not, “And then that doesn't mean that we don't have enough data or it's not safe.” I actually do think that when the FDA evaluates this, they will find the vaccine to be safe and effective. The fact that it will be an EUA and not a full approval really means that we have to continue collecting data and continue looking at the things.
And the only last point I'll make on this, Colleen is that I think it the timeline at this point is probably two to three weeks is what I'm guessing people are saying mid December, I suspect it might be faster than that there's such an urgency that I suspect FDA will authorize emergency use in the next two, three weeks, they just have to look at all the data and then make make some determinations.
Is there any situation where you think they will not get the authorization?
I mean, again, I haven't seen the data, right? I've just seen the press releases. But in general, I don't tend to trust press releases. But in this context, the stakes are so high that the idea that Pfizer would have misrepresented things in the press release, I just don't buy it.
I think everybody's being extra careful. So I suspect that the full data will be very consistent with what's been in the press release. And therefore I suspect that the FDA will authorize emergency use, the cost of not doing so is way too high. And in terms of delays, and obviously if the safety or efficacy data isn't there, then they shouldn't authorize it. And I suspect they won't. But my guess is that the data are there and they're authorized.
And on the topic of Pfizer, we also heard this week that they chose Rhode Island as one of the four states for their pilot vaccine delivery program. What does that really mean for the state? And what will that look like going forward?
Yeah, it's a very good question. And we're starting to hear a little bit more about distribution from the federal government. Pfizer is one of the major vaccines that has not taken Operation Warp Speed money. And so they really are developing their own distribution. And as we've discussed before, their vaccine needs to be stored at minus 96 degrees Fahrenheit. And so as you might imagine, it's complicated and not every place can handle it.
So, part of their distribution planning has been to pick a few states, and work with those states to get the vaccines out quickly once it's authorized. And the part that I'm a little less clear about is what they're saying, as well, it doesn't mean that these states will get it first. And I think well, what do you mean, it doesn't mean what I would have thought that that's what it would mean.
But certainly my sense is once it's authorized, I can imagine Pfizer vaccines going to these four states earlier. And my guess is that these states, like the Pfizer vaccine, will go first to come to the state frozen and then they'll go to the healthcare facility, so for health care workers, and so if you're a healthcare worker in Rhode Island, my sense is you're probably gonna be among the first to get vaccinated. But, but you know, a lot of details we don't know yet. But I'm thrilled like if we should be on the vanguard, we should be doing this and Governor Raimondo has been really, I think, terrific on being on the forefront on vaccines.
For the past two weeks, we've been talking about cases rising across the country. With Thanksgiving coming up next week and students traveling home from universities across the country and people traveling home perhaps to visit family, we're wondering how you think that's going to impact the change in the number of cases?
Yeah. So there's been a lot about travel and the CDC came out yesterday and basically told people not to (travel) if they can avoid it. And I think that was right. And I still think people will do some traveling.
I do expect that it will lead to another spike in cases. You know, we've seen this pretty much every single time (there was a holiday). We saw it on Memorial Day, July 4, Labor Day. After every holiday, you see a spike in cases. And it's a reminder that a lot of transmission is happening within households as people get together. So I think that's going to be a real problem, given how bad things already are. So it's a spike on top of a kind of baseline that's really rising quickly and is very high.
And then obviously, we all have to think about what we can do to reduce it. And for me, it's a no-brainer that families should not be getting together. I usually get together with my extended family — sometimes my in-laws, sometimes my parents. We’re not doing any of that this year. We're going to have a little family Thanksgiving and what we may do is — we've been talking to some friends — get together with some friends outside and like go for a walk with another family. And I think that's pretty safe.
There is a bigger question of how do we help college students get home safely. And the short answer is, there's no super easy way (though) there's a lot we can do to reduce risk. My general feeling is people should get tested before they go home. And they should get tested as close to going home as possible and that depends a little bit on how you're traveling. If you're driving three hours in a car by yourself, then that travel was probably pretty low risk. If you're flying internationally and doing two stopovers, that's a bit more risky. I still don't think flying and the travel thing itself is super high risk, as long as you're wearing a mask the whole time. But obviously, it is a little bit more high risk, or a little higher risk.
And then it's about really being careful at home. Because what you don't want to do is you could have picked up something and then spread it. And so what does that mean being really careful at home? The official answer would be when you get home, you should do a two week quarantine in your own room. That's gonna be pretty tough for a lot of people. A lot of states are moving towards for instance ... the kind of quarantine idea of like seven days plus a negative test afterwards. So if you can get a test at home, that would make a big difference. I also just think, if you can really try for the first seven to 10 days to be more careful wear a mask around the house if you can — I know it's not super exciting. And then after that, you become part of the household and then you can go back to being normal. But there is that week to 10 day transition period that I remain a little bit worried about.
I don't think it's super high risk if you've tested negative and then gone home right after. But to the extent that people can really try their best to minimize things in that first seven to 10 days when they're home. There is no simple way out of it. I mean, obviously, the safest would be you go home, you go to your room, and you stay there for 14 days. But my guess is that's pretty unrealistic for most people. So it's all about risk mitigation.
As students at Brown, we've had access to a robust testing infrastructure ever since we started school in September. And now we're all probably going back more or less to places that don't have that same consistent testing available to us. So how do you think students should think about adjusting their pandemic mindset?
Yeah, this is going to be a bit of a challenge. I mean, it's interesting, because one of the questions about whether it was safe to bring students back to campus, I often made the case that it was safe and in fact, potentially even safer because there were things we could do on campus that people weren't going to get access to — almost nobody is getting access to twice a week testing if you're not on on a college campus.
I do think testing will become more available as we go later into December and January. So it may be that depending on where people go, that there may be some added testing that is available. I doubt anybody's going to be able to get twice a week, asymptomatic testing, when you're home. I mean, I wish we could, but we just haven't built that kind of infrastructure.
And so it does mean being that much more careful, because we know so much of the spread is asymptomatic. And, so if you're at home, and you're spending time with your friends indoors and not wearing a mask, you could be spreading the virus and you're not going to pick it up, and you're not able to get tested, and you're going to give it to your family. And so, particularly right now, my relatively strong advice to people, is over the next two months, just do as little as you can get away with. It's such a bad time — we have two things happening at the same time: we're in the absolute worst phase of the pandemic and things are going to be horrible for two months. And yet, we can see the light, and the light is so bright, and just like so there's an element of, if you can avoid— I know, like, it's all socially isolating and tough— things for two months, it would make an enormous difference.
This week, we saw that Brown shifted away from in-person classes, which is a lot less drastic of a thing to do than some colleges that have just shut down in the last couple weeks at the very end. I'm curious what you think about that? And as you know, Brown is letting kids stay — do you think that that's the right choice? And are you maybe more concerned about some other schools that are going to be sending kids back?
Yeah, one of the things I've really liked about Brown — and obviously I'm biased because both I am here and I actually get to influence some of this — is I've always believed that you have to see this as a dimmer switch and not an on-off switch in terms of controls. And so we've clearly seen in the last few weeks cases going up a lot in Rhode Island. And then in the last 10 days, we saw cases going up a little at Brown — not a lot, no big spikes— but a little. Ultimately, this was a decision made by President Paxson but the discussion that all of us had was what do we do? Do we want to intervene at all? And my entire advice, like every single policy person, is it's always better to overreact than underreact.
And not to say please overreact, but to say, if you're on the fence, do more. And she made what I thought was a really sensible decision, which was, there was nothing dramatic about what she did, right? She just said, okay, in the last week we're just going to dial it back a little bit. And I think that's good. I think that's helpful. And then we will allow people to stay. I think a lot of universities — and I get why they do it — but I think they're really being irresponsible when they just shut down kind of abruptly, and they tell people to go home. Because, I mean, for some people that might be easy, you live two hours away by car, but for a lot of people, it's a real challenge.
And then all the risks we've talked about, about going home, come into the forefront. So I've always said that if you're going to bring students onto campus, you are responsible for getting them home safely. And, you can't take the approach of “out of sight out of mind,” like, “it's not my problem anymore; you guys figure it out,” — that's irresponsible, right? It's not what we're supposed to do as universities. And I feel like many universities are doing that. Obviously, Brown is not and I would be very upset if it was, but that's not what we're doing.
Thank you so much for all that good advice. I think that will really help people in thinking about what their plans are going forward in the next….oh, gosh, Thanksgiving is less than a week away.
I was wondering if there's any good news that you read about this week, besides, or it could be vaccine related, could be therapeutic related.
Yeah. You know, I'll tell you in Rhode Island and across the country, we are starting to see a lot more testing come online. I think we're able to double the number of tests Rhode Island is doing in the next few weeks. I think that's going to help a lot. And overall, I really do see our ability to have a more, I don’t want to call it a normal spring, but a better spring. Because it's not just vaccines, just becoming more and more optimistic about what we're gonna be able to do on testing. And just as testing got us, you know, to two and a half months of really good in-person experiences at Brown, I think that's going to become much more widely available. And so I've just, I get more and more optimistic about 2021 every day. And that's what makes it that much more compelling that we just hunker down for two months. We're not talking about hunkering for a year, right. We're just saying two months. And it's already been a long time— this pandemic has strained all of us. But if people can kind of do it for a couple more months, it'll make an enormous difference.
Thank you so much, Dr. Jha, we learn something new every time you talk, and oftentimes many new things. So thank you.
Thank you and stay well. And I look forward to continuing to do this and keep people informed and engaged. And it's just been a pleasure this semester doing this with you all. So thank you. Be well. Enjoy Thanksgiving.