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The COVID Pod with Dr. Ashish Jha: Approaching a More 'Normal' Fall 2021

On the last episode of The COVID Pod, recorded on the morning of April 9, 2021, Dean of the School of Public Health Ashish Jha is back to comment on Brown’s plans toward a more traditional semester in fall of 2021. The COVID Pod team discusses advice for the incoming class of 2025, efforts to promote more equitable vaccination in the state of Rhode Island and how to stay engaged with public health information even when the overall gravity of COVID-19 improves with vaccination efforts. 



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Cate Ryan

Hello, and welcome back to The COVID Pod with Dr. Ashish Jha. Today is Friday, April 9, 2021, and today’s episode is our last of this season and perhaps our last episode in this form as The COVID Pod for a while. So with that, I’m Cate Ryan, and I’m here on Zoom with Emilija Sagaityte and Rahma Ibrahim.

Emilija Sagaityte

Hi everyone, I’m Emilija Sagaityte, senior editor at The Herald.

Rahma Ibrahim

And I’m Rahma Ibrahim, a science and research editor here at The Herald.

Emilija Sagaityte

And it’s so great to be back here with The COVID Pod team and with all of our listeners for our final episode.

Cate Ryan

To mark our season finale, the three of us are glad to be back with Dean Jha. A lot has happened since our first episode aired on October 17. Multiple effective vaccines have been authorized and implemented in wide swaths of the population. A new president entered the White House. The nation has gone through peaks and valleys of case counts. And we reached the one-year anniversary of the COVID-19 pandemic.

The three of us have also almost completed another academic year at Brown, mostly online. Overall, we are getting closer to the light at the end of the tunnel, and despite the uncertainty of this year, our conversations with Dr. Jha have been a source of comfort and guidance through it all. We hope you have found the same comfort that comes with information through our questions and his words.

On today’s episode we are specifically talking about what next year could look like for college students, and we are continuing to dissect the current state of COVID-19 in Rhode Island, but also in the world.

***

Cate Ryan

So yeah, just to start, I wanted to say this will be our last episode of the semester, but also, I guess of the academic year and of this whole time. Also this is National Public Health Week, which I think is a fitting end to our podcasts.

Ashish Jha  

I just want to say, I've really loved doing this. This has been one of my absolute favorite things. This morning, when I was looking at my calendar for the day and thinking this is our last podcast, I got sad. I was like, “Oh, I want to do more.” Look, it's fine. Every good thing must come to an end. You should end on a high note. This has been fabulous. But so I'm not asking you to do more. But I am saying I'm sad that we're ending.

Cate Ryan 

Yeah, we're sad too. I know. I'm graduating in a few weeks. And it's weird to have all these ends happening, even the podcast. But yeah, we're excited for this conversation today. 

Rahma Ibrahim 

So the first question, obviously on a more positive note, is the announcement about Brown’s future plans. And so this week, President of Brown University Christina Paxson announced that Brown will be moving toward a more traditional fall of 2021. Vaccines are going to be required for students returning to campus and classes and activities will resume more or less in the ways they were before the pandemic. And so we just kind of wanted to get your perspective on the plan, and also what this may mean for the future of Brown.

Ashish Jha  

Yeah, I thought it was a fabulous announcement. It had very clear hints, maybe even more than hints of optimism. I loved her line that the fall of 2021 will look more like the fall of 2019 than it will the fall of 2020. And I think that's right. And of course, whether that comes to be or not is up to us — if we do our job, right, I think that's right. And I think that's even in this and I just want to start with saying there's always a curveball that could be thrown at us that could really upend everything. I'm not super worried about that. So the idea of like, “Oh, we have a new variant that makes all of our vaccines ineffective, and then like we're in big trouble.” Is that possible? Sure. Is it likely? No, it's really unlikely. So I want to dispense with that as the curveball and say let's assume that things go more or less the way we're expecting. Everybody vaccinated. All the students vaccinated. I expect 95 percent of faculty to be vaccinated. There's a discussion about whether we can mandate staff be vaccinated, we’ll always give people exemptions for medical and religious reasons. But if we have more than 90 percent of the campus community vaccinated, it's gonna be great, it will look really good, it will look a lot like any other semester, non-pandemic semester. There may be some minor modifications, some things that will need to be done differently. And I think the biggest barrier to achieving a normal semester will be psychological, not public health. It's hard to go from a year of a pandemic, to imagining yourself sitting in a classroom, with 30 other students and a professor in a small classroom, and not wearing a mask. Like, that's gonna be hard for people. And just because it's safe, doesn't mean it's easy. And that's what we're gonna have to work through, a lot of those issues.

Rahma Ibrahim 

Yeah, definitely. And I think just on that note about getting these high vaccination numbers, obviously, a lot of students have not gone through the process of getting their vaccine. And so when students become eligible and are about to approach that process of signing up, we're wondering what advice you may have for that whole process?

Ashish Jha  

Yeah. So students, actually pretty much everybody in the country, every adult over the age of 18, and in most places over the age of 16, will be eligible to get a vaccine by April 19. That's really, really soon. And I expect that everybody who wants a vaccine will be able to get their first shot, probably by early May at the latest. And so what I've been saying to folks is, first of all, don't obsess about which vaccine. I can make the case that you should get — I mean, I do make the case any of the three, you can make the case for J and J over the mRNA vaccines, other people will make the case for the mRNA vaccines over J and J. It doesn't matter. There are three terrific vaccines, so get any of them. The clinical trials, and the real experience of people has been that these vaccines have been really well tolerated. Expect a sore arm — if you're a baseball pitcher, probably go with the arm that (is) not your dominant arm, you'll have a sore arm for a couple of days. And then 30, 40 percent of people have some level of systemic symptoms. What do I mean? They feel tired, they get chills, a small proportion of people feel really, really terrible for 24 hours. But that's a very small minority. And more often after the second shot, and more often with Moderna. So I got Moderna. After my second shot, I felt exhausted for 24 hours, and then I was fine. So expect some of that, but then expect this huge sense of relief that washes over you, this sense that you really are protected against this virus that's been out there and circulating. And that's awesome.

Rahma Ibrahim 

Yeah, absolutely. And so that same day that the announcement came out about Brown’s traditional — or move towards a traditional — fall of 2021, the class of 2025 also received their admissions letters. And so we're just wondering if you have any advice to that incoming class, if they're listening to the podcast?

Ashish Jha  

Yeah, I do, which is welcome to Brown, this is going to be great. And you know, they are going to be the first class, the first post-pandemic class, and I'm a little weary to say “post-pandemic” because we're not gonna be fully post-pandemic, and we're gonna have some restrictions here or challenges. But the globe will certainly not be post-pandemic. But this is gonna be the first class that's going to walk in and get a chance to define the future of Brown, define what life looks like, because COVID is not going to be gone for years, maybe ever — forever. And we're going to have to learn how to craft a new way of living that's rich and meaningful, and this class is going to get a chance to do that. So it's going to be exciting. And the thing I will say to the students, but probably more importantly to their parents, is we’re going to be really focused on making sure people are safe. So it's not a, “we're gonna go back to normal and kind of act like nothing happened” — we're still gonna pay really close attention. There's a lot of work that's going to go on behind the scenes to make sure that the traditional fall semester is a safe fall semester. So we're not really done with this pandemic. And we're going to continue doing that work. But it should feel really good to be here in the fall and be able to meet and engage with people and experience college. 

Rahma Ibrahim 

So we definitely know that college students, at least at Brown, will have this more traditional future, but we're wondering, for schools, like K through 12 schools where most students are not yet eligible for the vaccine: How do you expect that they can have this more traditional fall of 2021? How can they move towards that as well?

Ashish Jha  

Yeah. So there's a lot of uncertainty on a variety of issues. So let me walk through some of them. I think there's a better than even chance that we're going to have Pfizer authorize for kids 12 and above by June, in which case, by June or July, 12 and above kids will be able to get vaccinated, and that all of a sudden means middle school and high school kids should be able to come back in the fall vaccinated, which raises the question, “Are school districts going to require that kids be vaccinated?” They require other vaccinations. I would favor it, I would favor those. Because at that point, you've just — you should be able to have a really normal fall with little to no restrictions. If they don't require it, and if a large chunk of kids don't get vaccinated, then the fall can still, should be in person. But then you're doing things like everybody's wearing a mask, and you're having to think about staggering schedules, and all the stuff you really need to do to keep things safe, need to still be in place if 30, 40 percent of kids or 30, 40 percent of teachers and staff are not vaccinated. And I think there are gonna be some really important policy conversations about “How much restrictions should we put in? How much accommodation should we do as a society for people who are choosing not to be vaccinated?” That's a really important question. It's very different when you didn't have a choice. And the other part, of course, is there are people who choose to be vaccinated, but who may have immunocompromised states and are still not going to be at some risk after a vaccine because maybe the vaccine won't work as well for them. And for those people, we do want to protect them. So it's a much bigger debate. And then under 12, the good news is those places tend to be safer —  younger kids tend not to spread the virus as much as older kids, there is a small chance that we'll have good data to be able to vaccinate kids under 12 before the fall, but it's low likelihood, I think that's probably more mid- to late fall or even winter. And so the fall is going to be kind of the — I feel like that's gonna be the transition semester for K through 12. By spring of next year, I mean my gosh, it should be 100 percent. But I actually think even this fall should start feeling close to 100 percent for large chunks of K through 12.

Emilija Sagaityte

So thinking about kind of these efforts to either require vaccinations or even just keeping to encourage people to get vaccinated. We've also spoken, though, about the issue of health disparities before and it seems this question is still very much prominent as to how do we make sure that people get access to the vaccine and, like, equity in terms of providing health care. And so this weekend and next weekend, we've learned that Rhode Island is organizing these mass vaccination efforts for people of color specifically in the state. And so what do you think will be the impact from these types of efforts, or hope?

Ashish Jha  

Yeah, absolutely. Really good question. So I think one of the things that we've learned in this pandemic is, for a long time, people used to talk about vaccine hesitancy among people of color, which to me, and the data really bears out that that's the wrong way to think about this, that the primary issue for vaccinations among people of color is the issue of access. And we need to dramatically increase access, make it easier. And that is starting to happen in some states. So I'm thrilled to see what Rhode Island is doing this weekend around really targeting and making access a priority for people of color. 

Rhode Island's done a lot on this already. They did that with Central Falls, they've done it with other zip codes. So in general, I think Rhode Island has had a very good strategy on this. But we obviously could all continue to do more. You know, at some point and again, it's probably end of April. Right now demand still outstrips supply. So we still have this issue of if you want a vaccine, you gotta sign up, you got to get up early in the morning and try to look for appointments and you got to keep hitting refresh on your browser. In May, you should be able to walk into a CVS and get vaccinated. And at that point, the ground game also shifts so that I want Johnson and Johnson vaccines sitting in refrigerators in doctor's offices, and when someone walks in and (sees) their doctor for something else, the doctor can say, “By the way, you should probably get vaccinated and I've got some J and J vaccines, and I can give it to you now and so it's a one and done. Right so there's a way to, like, make access so ubiquitous that it'll become much much easier for people to get vaccinated. And doctors and others who are trusted voices can really become the way forward on that.

Emilija Sagaityte

Yeah, I think we all are hoping that we can get there hopefully soon and kind of see the effects of that. But then also kind of thinking then about this position that Rhode Island is in and has been in with all of its efforts just over the past year, are there any characteristics that you think put Rhode Island in the position where like these types of mass efforts and with like vaccinations opening up soon, like we talked about in the state? Like, what do you think helps make that possible here? And in turn, is there anything we can learn from this? Or anything else that other states could do to maximize those types of initiatives as well?

Ashish Jha  

So Rhode Island, you know, you don't want to ever put too much on one person. But I will say that a lot of the success of Rhode Island's efforts is because of Nicole Alexander-Scott, our department of health director. She's extraordinary and has done a really, really good job of making sure that equity is a big part of the focus for getting people vaccinated. And so again, making vaccines available in certain communities early, really doing outreach through local leaders to those communities. I think that kind of stuff Rhode Island has done a fabulous job. And the way Rhode Island, by the way, has targeted making vaccines available for older people. So about right now, last time I looked, about 86 percent of people over 65 have gotten at least one shot. That's phenomenal. I mean, first of all, I wouldn't have thought we could even get there because of just hesitancy alone, I would have thought it'd be a bigger number. And that puts Rhode Island as third or fourth best in the country in terms of vaccinating older people. But again, it's older people, it’s people of color, it's high risk people. And the lesson, I guess, the key lesson is this stuff doesn't happen naturally, you have to be proactive, you have to be deliberate. You have to put in effort, resources. And Rhode Island has done that largely because of the leadership of Dr. Alexander-Scott. But then also with real support these days from Governor McKee, who I think has been doing a very good job as well. So the whole team, I think, is pushing this and that's what's making it possible.

Emilija Sagaityte

I think that's really great to hear. But I guess one thing, though, that then still kind of worth thinking about is, even as we kind of see this promise of whining vaccine administration, and this path towards normalcy — we've also heard, like, about the U.K. B 1.1.7 variant, and that becoming the most prominent form of COVID-19 cases in the U.S., and you touched upon this a bit earlier this morning. But thinking about that variant, and kind of the national and global situation right now, what do you think that that will mean, if anything, really for continued vaccination efforts, and just public health overall, even if we have, even if we were able to reach more equitable and wide vaccine administration?

Ashish Jha  

Yeah, so let's talk a little bit about variants. And, so B 1.1.7, the one from the U.K., is the most dominant strain of the virus right now. Depending on which measure you use, 50 to 70 percent of all infections in the U.S. are probably from B 1.1.7, and that's because it's more contagious, and it's spreading reasonably quickly in many places. The good news about B 1.1.7 is our vaccines work terrifically well against it, like just all three vaccines are terrific in providing protection against infections from B 1.1.7. The things that we worry about more are (B.1.)351, that's the one originally from South Africa, or P.1, the one from Brazil. And there, the good news is our vaccines I think are going to largely hold up, but there is more immune escape. And that means slightly higher rates of reinfection. It means more breakthrough infections among vaccinated people. And so it doesn't provide the same level of protection against those variants. Those variants are not as common, but they are here in the United States, and we are going to see some breakthrough infections. The good news is we've seen no evidence that anybody who gets infected from those variants ends up getting super sick or dying if they've been vaccinated. So it seems like the vaccine still holds up in terms of protecting you against severe illness.

Cate Ryan

Switching the conversation now towards more reflections for the future, I wanted to ask: So last time on the podcast, you mentioned how pandemics open new possibilities. And one example of this I think comes close to home, which is that Brown announced there have been more MPH applications this year. And also as we talked about Brown returning to normal, of course this new normal will exist in the context of the post-COVID-19 pandemic world or I guess, concurrent COVID-19 world, but I think that means new opportunities for academic endeavors, but also new ways of looking at the world. So how do you see these new possibilities unfolding?

Ashish Jha  

Yeah, I mean, the future is very bright on all of this stuff. So first, to your first point, Cate, absolutely, like the applications to the School of Public Health at Brown are up 110 percent from last year, like just stunning. And schools of public health, in general, have seen about a 25 percent increase. But we're up 110 percent. But it's across the board — applications from African-American students is up about 170 percent so almost tripling. From Latino students it’s up about 150 percent, just these stunning, stunning numbers. And it's not, it's not about Brown, it's just about the broad interests that there is in public health and how much people want to go into public health, which I think is great. So that's, I think that's terrific. You know, the kinds of possibilities it opens up are really interesting, right, like, so for instance, we've all done Zoom learning over the last year. And I think we all agree that there are some huge advantages and some massive disadvantages. And nobody wants to be in a Zoom environment for the next, you know, for forever. But it does open up some possibilities. So when I think about, like — I've been thinking about collaborations with other institutions and other places in the world. And someone brought up like, “Could we host some joint classes?” And I thought, huh, right. Like, maybe what we do is some of the lectures are joined between, imagine, us and a public health school in India. And it's a joint course. And the lectures are held, like, you know, kind of early for Brown, and kind of late in the day for that institute, in Delhi or something, but that the lectures are held together, and a lot of the breakout groups are on Zoom. And then you still do some stuff in person. Like what an interesting experience that could be. And that, I don't know that I had ever thought about jointly running classes with institutions outside of, you know, outside of Brown. I wouldn't have thought of it a year ago. So that's one small example of how institutions can start collaborating, students can start collaborating. There are literally hundreds of examples of things that we have learned that we can now do differently. And my biggest thing is like, we're gonna see a lot of this kind of stuff come out and into the forefront. And I think it's great. And then there's a lot of stuff we used to do where we thought you have to do it in person that I think increasingly we'll do online. And then there are a lot of things that we have learned, like relationships, learning, kind of the cultural stuff, very hard to do online. And, you know, it's interesting, because like, we've been talking about meetings that I've been involved in at Brown, that have been purely online, because I got here in September. And so I've been having conversations with people about how many of those we want to go to in person. And some chunk we will, because so much of this is about relationships that we can't hold. So workplaces, schools, education, research, all of that is going to change. It's going to look very different a year from now than it did two years ago. And it's hard for me to predict all of them. But my feeling is most of them are going to be better.

Cate Ryan  

Yeah, and I guess speaking about learning opportunities and things like that, I've also been thinking about how right now COVID-19 is still on the forefront of the national news and it permeates our Twitter feeds, our conversations with our friends, our daily lives. But as vaccination begins to allow things to move towards a new normal, as the Brown fall announcement sort of indicates, I anticipate COVID might begin to take a backburner, I guess on some of these outlets, and I guess our podcast ending today marks one version of that sort of a change happening in regards to how much we're talking about COVID-19. So how do you hope and how do you hope people will continue to stay educated about topics in public health and medicine now, but also into the next few years, even as COVID-19 eventually begins to fade out of center view?

Ashish Jha  

Yeah, so first and foremost, on a personal level, I can't wait until it starts fading out of everybody's kind of, you know, right in front of them. We all need a break from talking about COVID-19. There's a lot of important things in our lives that we all want to be thinking about and talking about and talking less about pandemics and more about those things, it's good for everybody. So I'm excited about that. It's not going to be gone. It will continue to show up in conversation. It will continue to be something that we think about. The goal is it should not dominate our lives the way it has. And I think by summer, this summer, it should be like it's receding. 

And then, you know, what's really interesting is I'm really curious how people are going to remain engaged in this. People have had a crash course in science over the last year, we've had a — there's so many people who have never thought about clinical trials and how they work. And I bet a lot more Americans understand what a phase three clinical trial is today than they did a year ago. And some of that people will be like, you know, “If I never hear about another phase three clinical trial, I'm thrilled.” But there are other people who are going to be really — who are really intrigued by this, and I've met people who are not scientists who find this up really interesting, and want to stay engaged. And that will mean a lot of the things that have popped up to try to meet this acute demand will go away. But some of it won't. And where I see the most interesting stuff is in how major medical and scientific journals are going to have to pivot. Because there is a large demand out there, much bigger than what existed two years ago, for science. And people are gonna have to figure out how we meet that in a post-pandemic world where it's not sort of urgent in the same way. But it feels important. So I think we're gonna see new things pop up. And certainly a lot of the podcasts that exist right now will go away, because again, the need for it will be less. But I can imagine, I mean, again, I'll tell you, I hope that you guys continue your podcasts. And maybe it won't be every week that we're talking about COVID. But maybe you'll still have me on every once in a while to talk about like health, public health in general. And we'll throw in a couple of COVID questions. But I think it'll become more incorporated into our lives as opposed to this dominant feature of our lives.

Cate Ryan  

Yeah, I definitely hope that there will continue to be public health conversations, even if it's not about COVID, at the BDH. And I think that, yeah, just to end, we're also grateful that we've had this time with you to talk about all of these things, because I think even just for the three of us and Colleen in the fall to make sense of these things, through these conversations every other Friday has been really meaningful. And I know that we've been able to share that information with the Brown community in a helpful way. And I know even just my friends will say that they've learned a lot listening to this podcast. So thank you for all of your time, over the past academic year, and for all of the conversations that we've had behind the scenes too to make this happen. So yeah, we're really grateful. And I was just wondering if you had any last thoughts or remarks for graduating seniors, the Brown community, anything as we enter finals period and the end of this school year, I guess?

Ashish Jha  

Yeah, well, first of all, thank you for having me on these things, it has been super fun. As I have said, I've enjoyed it. It's been really fun conversations, interesting, hard stuff that we're all working our way through. I guess I have a couple of reflections. One is, we've gone through an unprecedented time over the last 14, 15 months. Nothing like anything I face in my lifetime. And I'm much older than you guys. And what I've learned beyond all the like technical stuff, about COVID is that: First, it's a reminder that societies have gone through things like this forever — humans have been moved, there have been plagues and pandemics, that we can get through it, that if we use science, if we use evidence, we can keep people safe. We can create solutions, we created a vaccine in incredible time. And that if we communicate openly and plainly and focus on people's health, that we can get through crises together. In that way, this last 14 months, as horrible as it's been, it's given me incredible hope. 

And I guess the message to the graduating seniors and to the Brown community, is let's keep some of these lessons in mind. There are plenty of other crises, plenty of other challenges to get to deal with, right, climate change is going to be, it's not as acute as this pandemic, but it's every bit as complicated and arguably more. So what are the things we need? We need science, we need communication, we need to focus on what's important, which is protecting lives and well being. I think there's a lot we've learned here that we can apply to other parts of our lives. And if we do that, then this pandemic will have had a lot of benefits beyond just the horrible costs that it's had. And that, you know, I'm gonna go back to a conversation that I had with Tony Fauci in August, just before I started, we did this. Dr. Fauci and I did this thing and you know, and he said at the end of the conversation, he said, you know, this is August, right? The vaccines weren't out. We didn't know how that was all going to play out. And he said, you know, “Ashish, we are going to get through this.” And I said, “And we're going to get through it because of science.” And he said, “Yup, because of science.” And that's how we ended. Science is this incredibly powerful tool. It's not magic. It's a set of tools that helps us solve really complicated problems, whether they be pandemics, whether they be structural racism, whether they be climate change, there are scientific principles about learning and hypothesizing and testing those hypotheses, that have been responsible for so much of what's great about human life in 2021. And I think we just got to keep focusing on that and using that tool to drive improvements. And I think there's no better example of that than how we've gotten through this pandemic. And last, maybe, thing — I know, I'm going on too long — But I'll just say one last thing is, what science does not do is substitute for human connection. And that's been a really important part of this, too. So even though we've done it by Zoom, it's been an honor and a pleasure to be connected to all three of you, and to the entire Brown community and I want to say thank you, again, for having me on these podcasts.

Cate Ryan  

Thank you. And I'll say I was at that Fauci event covering it for the Brown Daily Herald and it is just amazing to see how far we've come since then. So thank you for all the conversations again.

 

 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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