How does an epidemiologist think through the little decisions each of us make during the coronavirus pandemic? Boston University\u2019s Ellie Murray explains.<\/em><\/p>\nThe global coronavirus pandemic can be seen many ways: as an act of God, a consequence of a shrinking world, a biological fluke. But if you\u2019re an epidemiologist, looking at the grim moment America finds itself in right now, you also see it another way: This was a choice.<\/p>\n
For months, each of us has made a cascade of seemingly small decisions about how to live during the pandemic\u2014whether or not to wear a mask, whether or not to quarantine, if and how to socialize, whether to travel for holidays or stay home. And then there are the choices that we have made as a country. Politicians have chosen to require masks, or push safety messages, or close bars\u2014or they\u2019ve chosen to ignore the virus and do none of those things.<\/p>\n
Cumulatively, those decisions have added up to the moment we\u2019re in. As families gather for Thanksgiving throughout the U.S., the country teeters on the brink of a coronavirus catastrophe. Records are being shattered by the day as new coronavirus cases and Covid hospitalizations surge upward throughout the country\u2014and, because people are about to choose to spend holiday dinners with family, it\u2019s likely to get worse.<\/p>\n
\u201cThe Thanksgiving increase [in Covid cases] is going to roll into a Christmas increase and a New Year\u2019s increase,\u201d says Dr. Ellie Murray, an epidemiologist at Boston University. \u201cThe current wave we\u2019re in may not peak until sometime in \u2014 maybe \u2014 February.\u201d<\/p>\n
At Boston University, Murray leads the epidemiology department\u2019s Causal Lab, which focuses on helping to improve and expand the use of evidence-based decision-making in everyday life. With Thanksgiving upon us and the holiday season at the doorstep, she wants people to pause and take time to talk with their families and loved ones about the Covid-related decisions they\u2019re making in their own lives.<\/p>\n
How does an epidemiologist think through those choices? And what exactly are we facing in the weeks and months to come? To talk through it, POLITICO Magazine spoke with Murray. A condensed transcript of that conversation is below, edited for length and clarity.<\/p>\n
In terms of the coronavirus, given both the sharp increase in cases and widespread travel over Thanksgiving \u2014 and given the incubation period for the virus \u2014 what should we expect in two or three weeks?\u00a0<\/strong><\/p>\nRight now, across most of the United States, cases are trending up, hospitalizations are trending up and deaths are trending up. That\u2019s a really bad situation to be in going into the holidays.<\/p>\n
I\u2019ve seen people say things like, \u201cWe just need to get through the next week, and then cases will start coming down.\u201d No. If there are transmissions on Thanksgiving, those will start to be recorded as cases over the\u00a0following<\/em>\u00a014 days, then reflected in hospitalizations a week or so after that, and in deaths around Christmastime. Even if everyone stops what they\u2019re doing today, we\u2019re still going to see an increase in cases for the next two weeks, because those transmissions have already happened.<\/p>\nThere\u2019s no plan for a coordinated national lockdown or anything like that. And that means the Thanksgiving increase is going to roll into a Christmas increase and a New Year\u2019s increase. The current wave we\u2019re in may not peak until sometime in\u2014maybe\u2014February. There will be a lot of illness and hospitalization and death. It\u2019s a really bad situation. That\u2019s the pessimistic view of what to expect.<\/p>\n
That may be a pessimistic view, but do you think it\u2019s also the\u00a0realistic<\/em>\u00a0view?<\/strong><\/p>\nYeah. You know, at any time, there\u00a0could<\/em>\u00a0be a set of lockdowns put in place, and if they are long enough and severe enough, that would force the curve down. After about 14 days of a lockdown being initiated, we start to see the case curve trend down or at least plateau. But it seems unlikely we\u2019ll have any kind of federal lockdown before January 20 [Inauguration Day].<\/p>\nOne might hope that states\u2014as they get overwhelmed and our hospital systems get completely inundated\u2014will start instituting more local-level or state-level lockdowns. And if that happens, we\u2019ll start to see the curves come down. Really, whatever happens with the case trajectory is about what politicians decide to do.<\/p>\n
In the spring, we heard a lot of concern that the number of Covid patients who needed to be hospitalized would completely overwhelm hospitals. For the most part, we ended up avoiding that. Are we looking at the realistic possibility of that starting in the next couple of weeks?\u00a0<\/strong><\/p>\nDefinitely. We\u2019re hearing from a number of areas in the country where hospitals are already overwhelmed, where all of their Covid or ICU beds are full.<\/p>\n
In the spring, a couple of things made it possible for us not to not get to that point. One was the lockdowns, which helped flatten the curve. But another is that the outbreaks were relatively localized, so health care workers in New York could be supplemented with health care workers from the Midwest or Florida or California, who could come to New York and provide respite.<\/p>\n
So you\u2019re saying that because Covid is now so widespread, it\u2019s not localized. And that means that there isn\u2019t a surplus of doctors and nurses we can ship in from another state, right?<\/strong><\/p>\nExactly. When the outbreak is everywhere in the country, there\u2019s nowhere for help to come from. There\u2019s nowhere for backup to come from.<\/p>\n
Places to put people who are sick? That\u2019s something we can potentially find: In the spring, New York was able to build field hospitals and have Naval hospital boats come in. But people who are\u00a0trained<\/em>\u00a0to care for the critically ill? That\u2019s a really limited resource, and those people are exhausted. They\u2019ve been doing this since January, February, March. A lot of them have gotten sick and died themselves. Many who survived are dealing with grief from watching so many people die, including their friends and co-workers.<\/p>\nThat\u2019s really the biggest concern: We are burning through our capacity in terms of personnel and their resources, energy and resilience levels. There\u2019s nobody else to come in and help\u2014unless maybe if the federal government were to say that nurses and doctors licensed in Canada or Spain or wherever can come and supplement our workforce. But the government would have to make that decision\u2014health care workers who aren\u2019t licensed in the U.S. are not necessarily able to work here.<\/p>\n
The public appetite for \u201cflattening the curve\u201d has abated. Why do you think that is?\u00a0<\/strong><\/p>\nI think there are a couple of reasons. The public health community viewed lockdowns and flattening the curve as having two goals: one, preventing hospitals and health care systems from getting overwhelmed in the spring; and two, to buy us time to implement and ramp up more concerted, coordinated public health responses\u2014widespread testing, contact tracing, isolation and quarantine of people who are either exposed or known to be infected.<\/p>\n
But in general, a lot of those ramp-up things didn\u2019t happen\u2014definitely not in a coordinated way at the national level. And because a coordinated public health response wasn\u2019t put in place federally during the lockdowns, for a lot of people, they didn\u2019t see \u201cflattening the curve\u201d as doing anything. People were giving up a lot. Many lost their jobs. They couldn\u2019t interact with their friends and family, and it was starting to be nice and summery outside, and everyone wanted to get back out there. And if we\u2019d done what we were supposed to do, they could have. But we\u00a0didn\u2019t<\/em>\u00a0actually do that. So that was one problem: People got sick of lockdown.<\/p>\nI think December 31 was the first time I saw anything about this \u201cunexplained pneumonia.\u201d It was like, \u201cOK, this is something to pay attention to. Any minute now, the established set of processes is going to kick in, and it\u2019ll be dealt with.\u201d<\/p>\n
Days went by. Then weeks, then months, and it was like there was \u2026 nothing. There\u2019s a process that should have been activated. And it wasn\u2019t. There was no response. We started hearing that even the stockpiles of masks didn\u2019t actually have any masks in them, or they\u2019d expired. Things that should have been relatively straightforward were not.\u00a0That<\/em>\u00a0is so different than I expected.<\/p>\nWe kept coronavirus cases low in the spring, but [lacking a coordinated national response,] we kicked the can down the road into summer. Then we had a summer peak and a\u00a0little<\/em>\u00a0bit of an attempt to control that, but mostly just kicked the can down the road into the fall. And now, all of our bills are coming due.<\/p>\nI\u2019m curious, and feel free not to answer if this is too personal: Is it depressing to be an epidemiologist at this moment?\u00a0<\/strong><\/p>\n[Pause<\/em>] It\u2019s really \u2026 Yes, it\u2019s depressing. It\u2019s frustrating. People ask me all the time: \u201cWhat\u2019s changed? What\u2019s new? What\u2019s the\u00a0new<\/em>\u00a0solution?\u201d The solutions right now are the same solutions they were in January, February and March. We just need to implement them.<\/p>\nYes, we\u2019re developing vaccines, and those vaccines are using a slightly different technique than in the past, and that has allowed us to develop them more rapidly. And yes, we\u2019re learning which treatments work and which don\u2019t, and we\u2019re getting a better idea of how Covid itself is transmitted. But you don\u2019t need to understand all those things to respond successfully to an infectious disease outbreak.<\/p>\n
New Zealand has done a fantastic job. Vietnam has done a fantastic job. Mongolia has had no local transmission and no deaths because really early on, they recognized the severity of the problem and put into place the things that have worked for public health outbreak-response for the last 400 years.<\/p>\n
There\u2019s this village in the UK called Eyam. During the Black Plague, it was the northernmost point in the country that the plague reached, because when it got there, the people made a decision as a town that they were going to lock down and completely cut off contact with the outside world. At the border of the town, there was a stone with a depression in it, and they poured vinegar in that and would leave money in the vinegar [which they intended to use as a disinfectant]. People from the nearby town would bring them supplies and leave them by the stone and take the money. And a huge number of people in Eyam died of the black plague, but it didn\u2019t spread beyond its borders.<\/p>\n
This was before we even had even an understanding of the germ theory of disease! They didn\u2019t know what caused the plague. They certainly didn\u2019t know that fleas were responsible for transmitting it\u2014it was a mystery. But the town is still there. It\u2019s vibrant, and there are people whose families have lived there for hundreds of years.<\/p>\n
We have better medical treatments now. We understand what a virus is and how viruses work. But our general public health response tools are basically the same: If you might be infected, don\u2019t come into contact with people who are not infected. It\u2019s frustrating that is still so hard to implement.<\/p>\n
That example really shows an understanding of causal relationships. You do a lot of work on that topic. With coronavirus, when it comes to causal relationships, most things are not 100 percent dangerous or 100 percent safe. How should we think through those decisions and weighing risks?<\/strong><\/p>\nA lot of times, really loud messages try to make things black and white\u2014\u201calways wear a mask\u201d or \u201cnever wear a mask,\u201d instead of \u201cwear a mask if you\u2019re going to be within 6 feet of somebody or if you\u2019re going to be in a shared indoor space\u201d\u2014but really, there are two aspects to think about.<\/p>\n
First, there\u2019s the risk of getting infected and transmitting that infection to somebody else. I still don\u2019t think it\u2019s widely understood that you can transmit infection even if you feel totally fine. A lot of people think, \u201cIf I feel sick, I\u2019ll just stay home.\u201d But you can feel totally healthy, infect grandma or your neighbor, and realize a couple of days later that you were sick. We need people to get more comfortable thinking about that.<\/p>\n
Second, which activities are risky, and how risky are they? This is where the idea of a continuum comes in. There\u2019s a rhyme that [epidemiologist] Bill Miller from the Ohio State University came up with for the four dimensions to think about: \u201cTime, space, people, place.\u201d<\/p>\n
Time: How much time are you spending doing this activity? The more time you spend, the more chance there is for transmission. The less time you spend, the less chance.<\/p>\n
Space: How much personal space do you have? Are you able to get a distance from people? Is it 6 feet or not? If you\u2019re singing or cheering, you\u2019ll need more space because your respiratory particles can travel further than 6 feet. The more personal space, the better. If you\u2019re out in the woods by yourself with no one around, you don\u2019t need that mask on, because there\u2019s no one to transmit to or get infected by.<\/p>\n
People: How many people are there? Are these people you see regularly? Are they part of your core bubble, or strangers? It\u2019s safer to spend time with mostly the same group, and safer to have fewer people in that group.<\/p>\n
Place: Where is this? Certain places are more conducive to transmission. A small room where everyone\u2019s packed in together is riskier than a large space. A museum is typically a much larger space than a bar, which is generally smaller with a low ceiling. Outdoors is safer than indoors. Indoors with the windows open is safer than indoors with the windows closed.<\/p>\n
Think through all of that. What are the activities that I\u00a0must<\/em>\u00a0do? What are the activities I just\u00a0want<\/em>\u00a0to do? How risky are they? How can I make them a little bit safer?<\/p>\nIs there anything that has surprised you about the way people have been making decisions during this pandemic?\u00a0<\/strong><\/p>\nYes and no. It\u2019s not necessarily the\u00a0way<\/em>\u00a0people have been making decisions; it\u2019s that I hadn\u2019t really grasped how\u00a0little<\/em>\u00a0anyone outside of epidemiology really understands about public health.<\/p>\nEpidemiology and public health, they\u2019re not widely taught. They\u2019re not taught in high school or elementary school. Until very recently, they weren\u2019t even taught in undergraduate college. We see news stories about, for instance, someone who was told to quarantine, and it turns out they had 100 people over to their house for a party, and they say, \u201cBut I didn\u2019t leave the house.\u201d Well, that\u2019s not what \u201cquarantining\u201d means. Quarantining means you don\u2019t leave the house\u00a0and<\/em>\u00a0nobody comes into the house and you don\u2019t have contact with anyone.<\/p>\nIt didn\u2019t occur to me that people didn\u2019t already deeply understand the concept of quarantine. And almost always, \u201cquarantine\u201d is used in the media when really it should be \u201cisolation.\u201d In public health, \u201cisolation\u201d is the term we use when talking about restricting the contacts of someone known to be infected. But people, if you poll them, think \u201cquarantine\u201d is for sick people, and \u201cisolation\u201d is for people who are not sick\u2014it\u2019s the opposite.<\/p>\n
This is an example of something we in epidemiology have to grapple with. We have really specific terminology that mean really specific things\u2014and it\u2019s often counterintuitive, almost the opposite of what nonepidemiologists might think. If you\u2019re not an epidemiologist, then you don\u2019t hear our epidemiologist-specific meaning. But how can we expect the general public to understand our messages when we\u2019re basically talking in a secret code where words they think have one meaning actually have a different meaning when\u00a0we<\/em>\u00a0use them?<\/p>\nA lot of times, I\u2019ll see something and think, \u201cWhat are people doing?\u201d Their decisions surprise me until I step back and think about what we did wrong in communicating about it.<\/p>\n
Over the past few weeks, we\u2019ve had a lot of positive news about coronavirus vaccines. Are you concerned that the prospect of vaccines in the coming months will make people more flippant about following Covid guidelines?<\/strong><\/p>\nThis is always a concern in public health, and it\u2019s actually pretty hotly debated. It falls under this idea of \u201crisk compensation\u201d\u2014that people have a certain level of risk that they\u2019re comfortable with, and the question is, if you create circumstances where they perceive that something they\u2019re doing is now safer, will they take\u00a0more<\/em>\u00a0risks?<\/p>\nTo a lot of people, this sounds like a thing that theoretically probably happens. But when we actually look at data, it doesn\u2019t appear that people really do that\u2014at least not in a clear, measurable way. On a population level, it\u2019s still a bit of an open question. You might think about, for example, when there were lockdowns, we all stayed in our houses, but when it was said that masks can make us safer, people put on masks and went outside their homes and cases spiked.<\/p>\n
It\u00a0feels<\/em>\u00a0like it should be a thing. But the bottom line is we really don\u2019t know.<\/p>\nLast question: With Thanksgiving this week, whether we gather with family in person or remotely via video conference, what should we have in mind while discussing the pandemic?\u00a0<\/strong><\/p>\nI hope that people will be thinking and talking\u2014especially with their families\u2014and being really open about what precautions they are and aren\u2019t taking, and that they\u2019ll be comfortable sharing that information and accepting what the other person is going to do in response.<\/p>\n
I hear a lot of people say things like, \u201cI stayed home for two weeks, then went to see my grandma, and my uncle showed up. And it turns out he\u2019s been visiting her every day after going to the bar. I had thought I was safe in that room.\u201d Or people who say, \u201cI showed up at a gathering that I thought was going to be small, but when I got there, it was a much bigger crowd, and no one else was wearing a mask.\u201d<\/p>\n
People are getting an idea of what they themselves are comfortable with, and that\u2019s helpful. But we now need to get comfortable talking about it with each other: What are\u00a0you<\/em>\u00a0doing? Is that something\u00a0I<\/em>\u00a0am comfortable with? If not, then you need to be OK with me saying, \u201cSorry, let\u2019s just chat on the phone or on FaceTime.\u201d<\/p>\nWe need people to be upfront and open and honest about what risks they are and aren\u2019t taking, and what risks they are or aren\u2019t comfortable with each other taking. That\u2019s the next step, especially over the holidays, when what people are doing in terms of gathering with each other can be emotionally fraught.<\/p>\n","protected":false},"excerpt":{"rendered":"
Are Your Choices Making the Pandemic Worse?, Politico Magazine, \u00a011\/25\/20 Yesterday was the Thanksgiving holiday in the US, kicking off the holiday season countdown to Christmas and the New Year. A season unlike any before it, after a presidential election unlike any before it, and a pandemic upending the world for most of the […]<\/p>\n","protected":false},"author":1001004,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[54],"tags":[],"_links":{"self":[{"href":"https:\/\/worldcampaign.net\/index.php?rest_route=\/wp\/v2\/posts\/11198"}],"collection":[{"href":"https:\/\/worldcampaign.net\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/worldcampaign.net\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/worldcampaign.net\/index.php?rest_route=\/wp\/v2\/users\/1001004"}],"replies":[{"embeddable":true,"href":"https:\/\/worldcampaign.net\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=11198"}],"version-history":[{"count":4,"href":"https:\/\/worldcampaign.net\/index.php?rest_route=\/wp\/v2\/posts\/11198\/revisions"}],"predecessor-version":[{"id":11225,"href":"https:\/\/worldcampaign.net\/index.php?rest_route=\/wp\/v2\/posts\/11198\/revisions\/11225"}],"wp:attachment":[{"href":"https:\/\/worldcampaign.net\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=11198"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/worldcampaign.net\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=11198"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/worldcampaign.net\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=11198"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}
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