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One year into the pandemic, and on the anniversary of the day Brown announced it would be closing to students and faculty in the wake of COVID-19 in March of 2020, The COVID Pod team welcomes Dean of the School of Public Health Ashish Jha to have a conversation about looking ahead. Dr. Jha gives his insight on health disparities and the mental health toll of COVID-19. The Pod team also discusses the future of medicine post-pandemic and what the fall of 2021 will look like on campus. 



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Cate Ryan

Today is March 12, 2021 — it is also the anniversary of the day, one year ago, when Brown University announced it would be closing and sending students home for an indefinite period in the wake of COVID-19 being declared a pandemic. That day, none of us really knew what the next few weeks would hold, let alone the next year. 

One year later, more than two and a half million people have lost their lives. That number is still hard to fathom, and the wide-reaching effects of the virus have permeated all aspects of life, but now, there’s also some things to be optimistic about.

Most students are back on Brown’s campus, studying in a hybrid format. And globally, roughly 325.5 million vaccine doses have already been administered. In the U.S., President Joe Biden announced on March 11 — yesterday — that all adults should be eligible for the vaccination by May 1.

Today we are again speaking with Dr. Ashish Jha, who is the Dean of the School of Public Health here at Brown University, and we are going to reflect back on the past year but also focus on looking forward. I’m Cate Ryan and as always, I’m virtually joined by Emilija and Rahma. We all haven’t actually seen each other in person since March 12 of 2020 when we gathered in the Brown Daily Herald’s office to put out what would be our final print paper of the semester.

Rahma Ibrahim

It's strange to think that we’ve been apart for exactly a year, when we’ve managed to work together on Zoom to produce things like this podcast.

Emilija Sagaityte

I think looking back at that time it's kind of interesting how, you know, we were getting ready to go home and speaking with friends. I remember a lot of people trying to hypothesize when we would return to the new normal. And people were hopeful, thinking maybe in a few months, maybe by this past fall. But certainly we’ve seen that the new normal was not just going to be right around the corner, and I think people kind of came to terms with that in a bit. And here we are still a year later, living in a very different March than we entered in 2020.

Cate Ryan

One thing that I sort of wanted to start with is a little bit different, which is the topic of mental health and COVID-19. Because when I think back on the past year, that's something that really stands out in a way that's different than what we usually talk about, which is like vaccination, and you know, what is a strain? What is a variant? Like all of these more scientific aspects, I guess. There also is this massive mental health toll that is super important. And I recently read a study about how roughly four in 10 adults in the U.S. reported experiencing symptoms of anxiety or depression during the past year. While I think that no one statement can really capture you know, what is everyone's individual lived experiences with this virus, statistics like that do sort of point to this generalized fact that (COVID-19) has had such a massive mental health toll. As a public health expert, how do you contextualize statistics like that? And what do you think should be done to promote awareness of mental health in society? And how might this whole experience with the virus change how mental health is dealt with in the context of schools and workplaces and things like that?

Ashish Jha  

Yeah. So Cate, that's really both centrally important and a big question. And I don't know if I have a lot of answers, but let me just maybe offer some reflections. And I'm going to actually start off with a little bit of a personal story. A couple of days ago, I was on a national public radio show, just talking about the one year anniversary that was about to come up of this being called a global pandemic. And they played a clip of Governor Baker from Massachusetts, and what he was talking about a year ago, and just talking about, like somebody who had died that he had known, and listening to him. And then they came to me after they played that clip. And I couldn't talk, and I was choked up, and I just, and you know, me, I'm usually perfectly happy to talk. And it was the moment that I realized, like, and I'm just speaking personally, like what an awful, like, year this has been in the sense that there's been this fog that's been sitting on top of all of us, and some more than others, right? Like, I've had a relatively easy time. I've had a job the whole time. No one in my family has, thankfully, gotten sick from this virus. But it's all of us, like every one of us has been living in this kind of awfulness of both — I think there's a bit of a disbelief that here we are a year later, and it's still unlike anything we've ever experienced. And, I've been, as you know, pretty public recently about like, how this is going to get better very soon. And a lot of what I get back from people is disbelief like this “can't believe it will ever get better.” So it will, it really will. But that's one part of this, kind of this, this collective awfulness, that's going to have an effect on all of us. 

But what you're getting at is a related but slightly different issue, which is, while it's affected all of us, it has affected some of us more than others. Some of it very directly in lost jobs, lost families, illness, etc. But for others, it's had this massive mental health toll — anxiety, depression, suicidal attempts. It's been huge for a lot of children for whom this is just, this is not a life they understand. And I mean, for adults, it's not a life we understand. And the ramifications, the impacts are going to be getting unpacked for years. And we got to get going, and we are not ready. I mean, we do not have the mental health workforce, we do not have, I think, any real appreciation for how deep the mental health effects are. So you're right, no single statistic can capture — the one you mentioned about four in 10 is a really powerful one. But this will be one of the big issues we're gonna be dealing with for years. And we've got to, we've got to focus on it and prioritize it.

Cate Ryan  

Yeah, I feel like it's interesting to think about how this is a global health issue, but it's also such an individual experience. And so many experiences are so unique, and we can't relate to all of them. But we can think about how to change the infrastructure to help people in new ways.

Rahma Ibrahim

And we also know that COVID-19 has had a disproportionate impact on some racial and ethnic minority groups. These effects have been pronounced in a time when I would say the media plays a more important role in keeping the public informed. And so the public has paid more attention to persistent health inequities than usual. So what would you say public health experts and medical providers, and the population really, have learned about health inequity during this time? And what do you think we still have left to learn and, of course, improve upon?

Ashish Jha  

Yeah, this is a good news, bad news story in my mind. So I think the idea that there are deep structural inequities is not something we have discovered for the first time in this pandemic. And there are many of us who've worked on issues of health disparities, health care disparities for years, who understood that we had a deeply unequal society. I think the pandemic has done two things: I think it has brought it into sharper relief even for those of us who've thought about this a lot in the past. But it has certainly brought it into plain daylight for a lot of people who didn't appreciate it. And so I think we can use terms like systemic racism in a way that is much more understandable to people. I think, a year and a half ago, two years ago, most people, a lot of people would have been confused by it. I think they have a better appreciation for it. And that's all great, like that is good, that is progress. We need to understand these issues, and we need to be able to talk about them openly. 

I guess I've been a little surprised there (are) still people in the medical community who struggle with terms like racism, and still see it very much as like, “Are you saying I'm a racist?” And my answer on that is, that's not what we're talking about. I mean, there is personal racism, and we all have that as a part of our legacy of living in this country. But we're talking about systemic racism, which is much broader than individual discrimination and choices. And that switch has happened for some but not enough people in the medical community. And I still see it among colleagues who bristle at the term systemic racism, and they need to get over it. And they need to deal with it because it actually has this profound impact on their patients that they're not paying attention to or are not aware of. And so if they're going to be good doctors, they need to understand it. 

So I look at this as like progress, but with a lot more to go. And then none of this gets at the solutions, right? Like this is all just identifying the problem. And I'm hopeful from some of the things I'm hearing from this administration, but elsewhere, that we are going to make some efforts to try to address some of the underlying issues around systemic racism. These are generational activities. I mean, we're going to be working on this for years. It didn't show up yesterday, but we got to get going now.

Cate Ryan  

Yeah, I think going off what you're saying about the medical community, Emilija, Rahma and I are all pre-med students hoping to eventually become doctors and practice medicine. And I think that we've all had conversations with each other and with other people about, you know, how are we going to use this eye-opening experience of COVID-19 and also thinking about health disparities in ways that are so much more, I guess, out in the open in a way that they weren't necessarily before to change how we think about medicine and how we become, I guess, the next generation of doctors. So how do you think that medicine will change as a result of this and what should future physicians think about in that context?

Ashish Jha  

Yeah. So the one thing I will kind of warn all of us is yes, it has been brought out into the open. And yes, there's a moment here, but the moment will not last forever. And if we don't take advantage of this moment to really work on change, we will go back to kind of the status quo, because that's kind of what happens: people have short attention spans, people lose interest, people lose focus. I have to say, I'm very, very hopeful when I think about, like, when I — and again, I don't want to turn this into an age thing at all — but when I look at younger physicians, and how much more attuned they are to these issues. So as you all think about medicine and say, you know, is this a field I want to go into? Am I going to find people who understand these broader systemic issues? The short answer is yes, you may find fewer of them among your senior mentors, but you'll find plenty of them among the more junior mentors. There's a whole generation of physicians, I think, that is much more attuned to these issues. And physicians also have a really loud voice. And I think that's one of the things we saw in this pandemic is that when physicians use that voice effectively, they can effect change. And so I think things like making sure that we have universal coverage in this country because it's insane that there are people who don't have basic health insurance coverage. That's something that physicians can argue for, it's very much in their lane. And I also think, by the way, the other part that makes me — and again, I'm obviously biased because I'm a physician who does public health — is I love watching physicians engage in public health conversations and saying that if we don't engage in these public health issues, we will deal with them downstream in the emergency room and in the hospital, which is much worse for patients and much worse for society. So I think what you're gonna do is you're going to walk into a field that's ready and primed for these kinds of changes. And I'm thrilled that you're seriously thinking about it, because we need medicine to change to address these issues. 

And one more thing on this is, which is, you know, I mean, I feel like we need medicine and public health to come more closely together. I, you know, again, I have huge biases on this, but I feel like most medical, most physicians should have a little bit of an understanding of public health, they don't all need masters of public health degrees, but they should have a little bit of understanding of public health because it will influence their clinical practice.

Emilija Sagaityte

Yeah, I think, definitely, we've seen a lot of change over this past year. And hopefully, that momentum keeps driving us forward to something better. But alongside that, also these developments in medicine and patient care, I also think we've seen science and research really take a spotlight this year as scientists first tried to understand the virus then devoted months and months to designing technology and protecting and treating the community. And also, of course, we've seen vaccines developed and released under emergency authorization. And so how do you foresee this experience for the United States and also in other countries impacting research moving forward, and how we kind of approach innovating to address illness and pandemics? What may be the upsides from your point of view, but also are there any downsides?

Ashish Jha  

Yeah, I think there's a couple of things that have been long-standing trends just like the the disparities and inequities conversation where it wasn't like, oh, all of a sudden, we discovered inequities in our society, they just got brought into sharp relief and became more obvious to a lot more people. In the same way there's been trends in global science that were moving for years, and they got brought into really sharp relief. So what are those? 

One is that science is global. Like, I mean, it's interesting to think about, you know, last January, January (of) 2020, the virus got identified and sequenced by a Chinese scientist. And like, two days after, was posted on the WHO website. A German scientist developed the first set of diagnostic tests to identify the virus. And like three, four days later, South Korean scientists had built the test that would be necessary. And so you went from like, the Chinese to the German to the South Korean, all within a week. Because that's how the world works. And, you know, people love talking about the Pfizer vaccine as, like, it is an American vaccine. And I'm like, it was built by a couple of Turkish immigrants who live in Germany, and run a company called BioNTech. And, and they worked with Pfizer because Pfizer definitely had a big intellectual role in turning the vaccine into some product that you could actually manufacture. Because you have to remember vaccines are not like regular pharmaceuticals, they’re biologic agents, and to produce millions of them is a whole scientific endeavor unto itself. And so did Pfizer have an intellectual scientific role? Absolutely. But is it a Pfizer vaccine? It's a BioNTech vaccine. Is it a German vaccine? Sure. Is it a Turkish vaccine? Yeah. And then at that point, you start realizing like, this is an insane conversation, what are we talking about? It's just, it's a human vaccine. So this is the kind of stuff that, like, that science has become deeply, deeply global. And that's how we have to understand it and look at it and work on. So that is one lesson, and I think it's a really awesome lesson. 

A second lesson is one that people who have very strongly held political views about how the world works are going to have a hard time with, but I'll tell you my view on this, which is, you know, the fact that we were able to produce millions of doses of these incredible vaccines, was this because of government? Sure. Was it because of the private sector? Absolutely. This whole split we've had of like, government does big things. No, government is terrible, the private sector does big things. And it turns out, neither could have pulled it off without the other. 

And so another major lesson is for big, bold, audacious things, you need partnerships. And if you're on the left, you tend to talk about the government playing this huge role. If you're on the right, you downplay the government's role. And I just don't find those conversations all that interesting, I think in this pandemic, it's been a classic, great public-private partnership. And we need more of those in the future if we're going to continue to solve big problems.

Emilija Sagaityte

Yeah, I think that speaking of those kinds of intergovernmental, but also just global, national and even, I think, local collaborations, here in Rhode Island and in Providence, I think we've all kind of been exposed to those and seen those over the past year. And so one of the things that we were also wondering is, having seen this research extend not only into our typical immunology and engineering, but also into public health, like you were talking about before. And it seems that this has really strengthened those collaborations, at least I think, here in Rhode Island. But I think that seems to have been true nationally, as well, between governments and our researchers and our physicians. So how do you perceive these relationships continuing after this pandemic? And how do you think that will impact policy-making, and just communication going forward? Do you think those newly established bonds will kind of remain and go stronger? Or might they taper a bit with time?

Ashish Jha  

There's no preordained path of how this is gonna play out. This is all going to depend on how we decide to use this. So these relationships, a lot of them have been forged in the middle of a crisis. And when the crisis abates, you can easily imagine the relationships kind of dissipating. But I'm more optimistic than that. And I'm more optimistic than that for two reasons. 

One is, while the acute phase of the crisis is going to abate, we are going to be dealing with, like building up better surveillance systems, building up better vaccination capabilities, building up better therapeutic alliances. So there's gonna be a lot of work. And I'm hoping that these relationships that were forged in this context will continue for that reason.

But the second is, you know, as a friend of mine was reminding me recently, he said, you know, COVID-19 was the pandemic, obviously, of 2020, and 2021. But we have a lot of other large epidemics, pandemics that have been happening. HIV is not gone. TB continues to kill millions …. Malaria. And so can we use these forged partnerships, to start trying to tackle some of those challenges that have not gotten the attention? Largely, they didn't get the attention because they happened in poorer countries. And so can we leverage these platforms we have built? And the answer is, I sure hope so. So part of it, and again, it won't just naturally happen. So part of our job, those of us who are in public health leadership, government, is to push these relationships and say, it's great that we have built these incredible vaccines using mRNA for COVID, can we use the same vaccine platform for malaria? It's an interesting question. But we need to start doing that kind of stuff. And I'm actually optimistic that will happen. So in that way, I look at the next decade as like a renaissance for public health and public-private partnerships and really doing great stuff and tackling the big challenges of public health that we have neglected.

Emilija Sagaityte

I think that's really great for all of us to hear. And it'll be interesting, I think, to see how it unfolds in the next year to come. 

Rahma Ibrahim

And now for a question that many students are eager, perhaps anxious, to get an answer to, and which you alluded to in the teaser in last week's episode: What can college campuses and school reopenings look like in fall 2021?

Ashish Jha  

Can I say pretty close to normal? 

Like, so let me talk about that. If — and again, I don't know what Brown University is going to do. I don't know what other universities are going to do. And I'm obviously not a legal person, like a lawyer. So I don't know what the rules are around some of these things. But I believe that if every student who steps foot on campus in the fall is vaccinated, and there'll be plenty of vaccines that they can do it, so there's going to be no constraints. And if more than 90 percent of faculty and staff are vaccinated, and again, we’ll have plenty of vaccines to get this all done by, like, June if we want. Then the fall should look pretty close to normal. 

Full classrooms? Yeah. Normal dorms? Yeah. Football games? I’m thinking like outdoor sports events, yeah. There's some small challenges, right? Like at an outdoor sports event, you have parents visit, they may not be vaccinated, or you're gonna have some chunk of people (who) are not vaccinated. So how much of that do you tolerate? As long as it's a relatively small number, it's probably okay. If it starts getting to be a big number then it starts becoming a problem. Some things may be a challenge, like, you know, I'm thinking about, like, things that bring large numbers of people indoors in a kind of a packed way: plays, musicals, some of the theater stuff, I think, still doable, but may require some extra work to make it feel normal. 

And then the only other kind of caveat I will put is, I expect a surge of this virus — surge is probably a strong word — a bump in cases from this virus in November, December, January. It feels like a pretty seasonal virus. And so I could imagine that, like, we need to act a little differently as we get into late November and December if cases are going up. But that feels manageable to me. And I have not described anything that people really love as part of their college experience, that I think people will not be able to do this fall. I can't think of what that is. 

The one thing that will be a difficult thing for this year is international travel. So obviously, that's a big part of the college experience. And that's going to be hard in many places that have not been vaccinated. But if you're doing international travel to high-income countries, you’ll probably be fine. And I think we need to work on this, but a lot of middle- and low-income countries are still going to be struggling. So there are some of those, but on campus stuff, I think there should be very little. 

One last question on this people have brought up is like, you know, what about the like, 200-person-large lecture hall? And my feeling on that is I'm not sure we ever needed to have that in person. And if some of those get turned into like virtual classes, and then you do the small groups together, maybe that's better. Maybe that's an innovation that comes out of the pandemic. So there might be some changes. I don't think it'll look like the fall of 2019. But it should look really good.

Rahma Ibrahim

Yeah, since a lot of this what we call going back to normalcy depends on vaccinations probably, what are ways you think college campuses can encourage students to get vaccinations? Can college campuses maybe start providing vaccines the first week of orientations or something like that?

Ashish Jha  

Yeah, it's an interesting question. We will have so (many) vaccines in the U.S. that college students should be, if they want to, be able to get vaccinated probably in May or early June. So the question is, and colleges are thinking about this, should we require them? Look, a lot of vaccines are required, right, to be on campus, so you could require it. I do think colleges should be providing it as well, to make it easier for people. But because it takes a little while to build up immunity, maybe you say to students, “Come back a few weeks early,” and to get vaccinated if you have not gotten vaccinated, but people should be able to get vaccinated. They're pretty accessible, free all over the place. And so, I think colleges should absolutely be encouraging it. And then of course, they're also going to have issues with what to do with faculty and staff. And I think colleges in general — and this is now getting outside of my area of expertise — but I think from a kind of legal and regulatory point of view, much easier for them to require it for students. And I think harder for them to require it for faculty and staff. Personally, I'd like to see them required for everybody, but I don't think we may be able to do that. But if we can encourage it, and make it really easy, that would be good.

Emilija Sagaityte   

Also, then kind of going off of the topic of college students — so one of the questions we actually received from listeners on our podcast was, what will our 20s be like? And that kind of got at least us three thinking about how we've certainly seen a lot of college students from first the class of 2020 and now 2021 end their years amid this virtual environment, so classes have been over Zoom, internships were virtual, interviews for graduate schools and jobs all kind of shifted to computer screens. And an interesting question we were all wondering that we hope to get your opinion on, though, it’ll certainly be interesting to actually watch it unfold, is how will this pandemic you think, impact people's transitions, essentially, from school and education, I guess virtually now, to the real world as they begin working and life returns to more or less normal?

Ashish Jha  

Yeah. It's a fabulous question. And, you know, I have a few thoughts and not a lot of answers, but let me just share a few of them. One is, pandemics change societies, they do, and so, like, people keep asking me, “When do we go back to normal?” and I'm like, “There is no normal, like, there's no 2019 ever, like that's gone.” And, that does not mean that, like, we'll be pining for 2019 and going, “Oh, I wish we could go back.” Like we're going to invent and create a new way of living, that will have features of what 2019 looked like, but will have features of other things. 

You know, I was talking to somebody who spends a lot of time hiring people for businesses. And they were saying that, you know, we used to, in our company, think about who lives within 40 miles of where they're going to work. It's not really clear that that feels like a constraint anymore, right? It's not at all clear that like, you can't hire somebody who lives across the country or across the world, and then have them come in every once in a while. That's a whole different model of how to think about where you work. So there's a lot of changes that are going to be coming. I think people graduating from college are going to get to live in a world where we're going to be figuring a lot of this stuff out, and work will look different, opportunities will look different. And personally, I think a lot of it'll be better. Because right now, it's like, oh, if you want to work for the tech industry, you have to like go live in the Bay Area, which is super expensive. Or not, you could go live in Alaska, if that's what you want. My point is, I think that there's gonna be a lot more flexibility. And people are going to figure it out. So we're going to get, you know, companies will try stuff. But I guess the last point, if I were giving advice to a graduating senior, I would say, like, be super flexible about this, really look at this as an opportunity to figure out what do you want your 20s to look like. What do you want jobs to look like? And understand that whatever job you go into starting this summer may look very different a year from now, may look very different two years from now, because companies are figuring out how to make all this stuff work. So flexibility is the key for the next few years.

Cate Ryan  

Yeah, as a graduating senior, I think that it is good to think in that way. And I'm looking forward to seeing what the journey to March 2022 will be like and where I'll be and what the world will look like. So thank you for having this conversation with us about the past year, but also what the future looks like. And I think it's exciting to see where we are now, given all the tragedy and experiences that we've all had in the past year. So thank you.

Ashish Jha  

My pleasure. It's been an awful year, but the next year will be much, much better. And we have a lot of work to do still. It's a global pandemic, we've got a lot of work to do. We're not done, but we should feel very optimistic about where things are heading. And it's been — I just want to say, you know, well, we're not done. But it's been a real pleasure chatting with you guys over the last six months or so in all of this and marking this journey together. So thank you for having me back on.

Cate Ryan  

Yeah, thank you. It's been really helpful for us just to learn as we go, and we're still learning. And I think we'll also be learning as we go towards March 2022.

Ashish Jha  

All right, be well and stay safe. Look forward to connecting up again soon.

 

This transcript has been edited for length and clarity.

____________________

Produced by: Cate Ryan 

Reporting contributed by: Emilija Sagaityte and Rahma Ibrahim

Sound mixing by: Cate Ryan

Music composed by: Katherine Beggs ’22.5

Special thanks to Bilal Ismail Ahmed and Elise Ryan for cover design.



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