COVID-19: Learning from the past, defining our future

RICK WEISS: Thank you, Josh. And welcome, everyone, to this media briefing. For those of you who are not familiar with SciLine, I want to let you know that we are a free, philanthropically supported, editorially independent service for journalists to help you get more scientific evidence into your news stories. Whether those stories are about science itself or about other topics where science can bring some credibility, some extra detail to those stories, we’re here to help you connect to scientists and to credible scientific information to strengthen those stories. And I encourage you to go to our brand-new, newly redesigned website, sciline.org, to see all the services that we offer you.

Today, we are taking something of a different approach than usual for us in a media briefing, and we’re asking a couple of experts to talk not just about what we know from science, but to talk at least a little bit about something we cannot really know, which is, namely, the future. But we’re not just asking them to speculate wildly. We’re asking them to ground their thinking about what the year ahead is going to be like by looking back at what the year past has been – a year that was full of surprises, full of revelations and, hopefully, full of some lessons learned – and to take a view from their – the lessons that we have learned through scientific disciplines ranging from virology to epidemiology to public health to the more personal but still evidence-based world of social and behavioral science.

Specifically, we’ve asked these two experts to think about some of our possible 2021s and to address the factors that are most likely to influence which of the possible 2021s ahead of us we’re most likely to get. What might the virus do? What might vaccines do? What might people do, behaviorally and otherwise, that might bend the arc of what kind of a 2021 we’re going to get? So to do that, we have two deeply knowledgeable and thoughtful scientists on hand. I’m not going to take time to give their full introductions now. Those details are on the SciLine website.

I’ll just say that we will hear first from Dr. Michael Osterholm, who is the regents professor in public health and director of the Center for Infectious Disease Research and Policy at the University of Minnesota, who will focus on the viral and epidemiological factors that are going to influence the year ahead. And then second, we’re going to hear from Dr. Camara Phyllis Jones, who is a senior fellow and adjunct professor at the Morehouse School of Medicine and past president of the American Public Health Association. And she’s going to talk about the U.S. health inequities that COVID-19 has so painfully highlighted over the past year and the potential consequences of American society either facing or continuing to ignore those issues in the year ahead. And so with that introduction, I want to turn it over to you, Mike. Take it away.

[0:03:06]

MICHAEL OSTERHOLM: Well, thank you very much, Rick, for having me. And it’s a real honor to be here with all the media. Let me just begin by giving you one disclosure I think is probably quite important to put into context. I think I know less about this virus today than I did six months ago. And so from that perspective, I want to make sure that all of you understand that I will speak in those terms. And if there’s anything that this virus has taught all of us over the course of the past 14 months, it’s the need to be humble. When one takes a look into the future, I think it is fair to go back, and at least from a standpoint not of facts, but of what I would call the psychology of this infection and what it’s done to all of us. I am at the – at this moment speaking to, obviously, a very talented group of journalists.

But I’m also speaking to people who every day themselves wonder, is today your day that you’re going to get infected? If you’ve already been infected, what – how did that work? What happened if you’ve had family members that have been impacted? I think it’s fair to say to understand this, one just need to look at – if you take today and recite the name of every person in this country who has died of COVID since the beginning of the pandemic, and you basically use a period of two seconds to say their name, you would literally spend almost 15 1/2 days saying those names consecutively in terms of the time it would take to know and honor all of those people. That’s a lot.

In terms of the pandemic itself, let me just also say that I think the psychology of the pandemic has influenced the media in a way that I’m sure that they may or may not agree, but I think it’s happened. I just have to start out by saying that at the beginning, it was hard for many to believe that this situation could happen. Our center at the University of Minnesota began dealing with this issue actually the last week of December in 2019 – did our first story on that. And early January, it became clear to us that this was not influenza, but it was a coronavirus, which was good news because it was like SARS or MERS. We could control that because people weren’t highly infectious until Day 5 or 6 of their illness. And then within a week of that, we became very convinced, no, this was unlike any coronavirus we’ve seen. Asymptomatic transmission is clearly a very important part of this transmission role. And on January 20, we put out a statement saying that this was going to cause the next pandemic. We needed to get prepared.

Later in February 22, I wrote an op-ed piece in The New York Times, saying this is a pandemic; let’s get on with it. And I have to say that during that time, I had a number of interviews with media who were actually quite – how should I say it? – negative about having me overstate the case of what was coming. It was just – it wasn’t about facts. It was about, you know, that can’t really happen. It won’t happen. I remember having a rather terse conversation with several media sources in April, after I was on “Meet The Press,” in which I said at that time to Chuck Todd that we were just in the foothills. We hadn’t even seen the mountains yet, and that it would last much longer than that. And the number of times that I was reminded that I surely was exaggerating the risk here and was scaring people needlessly – and I can go through, really, the duration of the past year. And for many media, they, in fact, did get it, understand it. But there was this constant undercurrent of, you know, is it really that bad? You’re just scaring people. And I think it’s really front and center right now. You ask about the future. You know, for the past eight weeks, I have been trying to get people to understand that the B.1.1.7 variant was going to be a huge challenge for us, that, in fact, with increased transmissibility and the increase in serious illness, that despite our vaccine efforts, it would be far too short, too little, too late to really deal with this surge.

And I have to say, the last three weeks – less so the last seven days, but in the last three weeks, the number of reporters who I’ve talked to who again wanted the good news story of this big drop in cases and what that meant with vaccine coming and – were disappointed, to say the least, in any comments that might have suggested, we got a ways to go yet. On top of that, I think that very few people really understood what happened in November with this pandemic. And when I say understand, is it – just taking a step back, realizing the implications of the arrival of the variants. Prior to November, we dealt with these mutated viruses, which were normally an expected part of the unfolding virology of this coronavirus. But those were variants that we all measured as ways of knowing how old the virus was, not from a functionality standpoint – didn’t really make a difference.

That all changed in November, when we now had data that the variants of concern really fit into three different buckets. And there were variants of concern – those that were more transmissible, those that produced more severe illness and those that could evade immune protection from either a vaccination or previous infection. And it was at that point that I think some of us, at least – in fact, maybe many of us – realized this was going to be a different ballgame. And I say that from the standpoint of what’s happening now. You can see what’s occurring in Europe with B.1.1.7, realizing that vaccinations are coming but surely inadequate to have a major impact.

You can see that what’s happening with the epidemiology, that even this very day, this news cycle we’re in right now has been influenced by this in the sense that the CDC just putting out new directives on the issue of opening schools. I, for one, was one that was a strong supporter of opening schools, particularly K-8 saying, you know, the epidemiology is compelling here that there’s just very little transmission to kids, from kids, by kids, and that we could open schools. Well, B.1.1.7 has turned that totally on its head. Right now, kids are a major source of transmission to and from themselves and to adults and as we saw in Europe, particularly in the early days of the experience in England, were the driving force in moving the pandemic through the communities.

So today, we’re taking old data on school opening, putting it forward, looking at the issue with kids, and we’ve got brand-new data. You know, I sit here today, and I look at this B.1.1.7 situation unfolding, and I think the future is going to be that the vaccines are going to have left us far short of the protection we could have provided to those 65 years of age and older. As I speak right now, about 19 million Americans in this country 65 years of age or older have not had any vaccinations at all. And that is going to be a group that could very, very adversely be impacted by this virus. And yet we have had, on a global basis, this discussion in England, which led to a decision to use one-dose vaccines. Same thing happened in Canada this past week. We’ve not even had a serious discussion of would there be a group of people in age 65 five years of age and older that if we gave them a single dose right now and spread out the vaccine, we could do that. Here we are opening up the country right now to everyone for vaccine, but everyone seems to forget the pipeline of new vaccines for the foreseeable future hasn’t changed. You know, it’s about 2.7 million doses a day.

So if you want to cut and dice it and add a lot of 20-year-olds and 30-year-olds or, you know, people in different disciplines into this, that just means there’s going to be fewer vaccines for that group of people who we have known are at highest risk of serious illness, hospitalization and deaths, named that and those over age 65. Now, we’ve surely done a good job in addressing that with up to 65% of 65-year-olds and older having vaccine, but we’ve left a lot left unprotected. Those are stories that will be the story of tomorrow when we see B.1.1.7 finally spreading through our communities. It’s starting to do in this country, and it is doing in a very efficient way in Europe. That’s an immediate future. The longer-term future, I think, that makes this such a challenge are the variants that fit into that third bucket, those which are able to evade human immune protection, either from vaccine-induced immunity or from natural infection.

Now, we have to say at the outset, there’s still lots of questions about this. Is that immunity compromised in a way of increasing deaths or serious illness or hospitalizations, or does it just mean that more people are likely to get infected but not have serious illness? Those questions still really remain. When we look at what’s happened right now in the Americas, particularly in Brazil, the countries of South America, while we’re watching P1, one of those variants that is so well-known by amongst all of us, we have to have a grave concern about where things are going forward. Most of you know that Manaus, Brazil, a city of 2.5 million people in the headwaters of the Amazon, had a major outbreak late last spring, early summer, in which they estimated up to 75% of Manaus had been infected. The deaths were in the thousands. And those that recovered left, what they thought, the community being – having hit herd immunity. There were actual articles published on that, which were generally agreed upon in the scientific literature.

Along comes this new mutated virus, the new variant P.1, and we suddenly now see a very different picture, one where another outbreak occurs in Manaus in November, December, January, which exceeded the case numbers of what happened earlier in the year. A number of people who had previously been infected were infected again, including some who died. And now we’ve seen that particular variant spread throughout much of Brazil, with some parts of southern Brazil right now – over a third of all the ICU units are actually closed to new admissions because of the situation there. We’ve seen another virus that has similarly had mutations that impact on the immune protection – B1351 in South Africa. We still don’t understand exactly what that means in terms of global transmission. But the bottom line is, is I think that we’re now in a time where the variant issue leaves us really wanting to know what the future is going to be like.

Now, some will say, well, that’s an exaggeration. And maybe it is to say that that’s – these are not going to be a problem. But I would suggest to you – a story that’s getting missed over and over and over again is what’s happening in the low and middle-income countries. COVAX, which was a vehicle for getting vaccines to low and middle-income countries, bringing together government support, philanthropic support in groups such as Gavi and CEPI were always meant to be largely humanitarian efforts, meaning that, in fact, that was surely a very legitimate reason why. But it was also only going to get a vaccine to about 20% of the populations in low and middle-income countries. Well, now I’ll say with certainty that if we have uncontrolled transmission ongoing in billions of people in low and middle-income countries, we are going to spit out more and more variants, some which could actually be more complicating in terms of the immunity picture than the ones we have now. It has suddenly gone now from dealing with low and middle-income countries from a humanitarian issue to a truly national security strategic issue of how safe will our vaccines be in terms of how well they’ll work going into the future. And that question should be looming large right now in all of our discussions about what is the world doing to respond to this.

Let me just close by saying, if you want to get a sense of what COVID-19 is doing and has done, just this past week, COVID-19 has been the No. 1 cause of death in the Americas. One-third of all the deaths in the Americas was COVID-19 this past week – two-thirds all other causes. That doesn’t sound like to me a virus that’s well under control and one that, in fact, we’re just about over with. Yet if you look at this country, we’re done. We’re done with the virus. We’re opening up everything. We believe that the good times are here. And they may be later next summer. We still have to understand what vaccine hesitancy will do in terms of the number of people that ultimately get vaccinated. We have to understand what these new variants will do.

And we have to understand in the short term what B.1.1.7 will do over the course of the upcoming weeks. So I think – if I have any one last message to say, I hope the media, basically, in looking at this, realizes we’re in this for a long time yet. This is not going to be over with soon. And people want it to be over with right now. All of us do. But the bottom line is it’s going to be a major journey up before we’re done with this pandemic.

[0:16:59]

RICK WEISS: OK. Well, thank you for that opening, sobering, level-setting remarks, Mike. I’m looking forward to getting into this with you. Before I turn it over to Camara, I want to remind people that – on this – on the variant nomenclature, B.1.1.7, commonly known as the U.K. variant for reporters; B.1.351, commonly known as South African; and the P1 is that Brazilian variant. And let’s move over to Dr. Camara Jones.

[0:17:25]

CAMARA PHYLLIS JONES: Thank you, and I’m delighted. First of all, I agree with so much of what you said, Dr. Osterholm. I think that we are premature in our optimism. I think this is going to be a much longer haul. And I also agree that we need to be aware that we’re in a global pandemic and that we are part of the rest of the world. I’m framing my remarks actually as kind of top-line ways for people to understand that racism is manifest in the disparate impact of COVID-19 on communities of color in this country. And I actually, as president of the American Public Health Association five years ago, launched our association on a national campaign against racism with three tasks – to name racism, ask how is racism operating here, and organize and strategize to act. And I encourage us to still do that.

You may be aware that in the country now, in the United States, there are at least 183 jurisdictions, cities, counties, in some instances eight states, that have named racism as a public health crisis, starting with Milwaukee County in Wisconsin, and then in response to COVID-19 and then the murder in May of Mr. George Floyd, more and more states coming on board. And even to this day, every month, there are more and more states that have at least one city or county that have made such a declaration. This is important. It’s important for us to name racism, but there are at least four key messages for the general public and for you all as journalists to understand when we name racism. The first is that racism exists because there are many people in staunch denial still that racism exists. The second is that racism is a system. The third is that racism saps the strength of the whole society. And the fourth is that we can act to dismantle racism.

When I define racism, I am clear that I’m talking about a system, a system that structures opportunity and assigns value based on the social interpretation of how one looks, which is what we call race. And the impacts include the fact that racism unfairly disadvantages some individuals and communities, but every unfair disadvantage has its reciprocal, unfair advantage. So racism unfairly advantages other individuals and communities. But beyond what’s happening at the individual and community level, racism is sapping the strength of our whole society through the waste of human resources. Of course, I’m happy to go deep in these issues with you later. That second – so beyond naming racism, as I said, 183 cities, counties, states have – in 33 states – have named racism.

But we need to move to that second step to ask, how is racism operating here? And that’s a legitimate question because racism is not a miasma or cloud. It’s a system with identifiable and addressable mechanisms which are in our structures, policies, practices, norms and values, which are actually the elements of decision-making, where our structures are the who, what, when and where of decision-making, especially who’s at the table and who’s not, what’s on the agenda and what’s not, including our media agendas. Policies are written how of decision-making. Practices and norms are the unwritten how of decision-making. And values are the why. And I encourage all of us to take this question with us everywhere, but especially when we’re trying to figure out what is at the base of excess deaths of people of color from COVID-19, where the top-line analysis is that we are more likely to become infected because we’re more exposed and less protected. And then once infected, we’re more likely to die because we’re more burdened by chronic diseases with less access to health care.

Well, how is racism operating here? Well, this is just going to be some top-line ideas, which could be story ideas, whatever. But with regard to structures, the racial segregation coupled with disinvestment that we see manifest all over the nation has turned into people being more exposed because they are – because of poor educational opportunities and like, pushed into front-line jobs or because they’re living in crowded housing. They are also – it causes – it’s at the root of the fact that communities of color are more burdened by chronic diseases because of limited food options, poisoned environments and the like. With regard to the written how of decision-making policies, well, limited personal protective equipment for low-wage essential workers is one of these reasons that they are less protected in the warehouses, meatpacking plants and the like. In terms of practices, part of the unwritten how of decision-making – well, the fact of the locations of testing centers and vaccination sites in affluent areas, which is directly related to less access to health care.

And in terms of norms, racism denial, which is staunchly held and so seductive in our society, actually results in a blame the victim – in kind of a – the early stories about the decreased numbers of people of color who were being vaccinated not only in comparison to their numbers in the population, but in comparison to the numbers in terms of how we have been affected, the stories were all about vaccine hesitancy as opposed to structural differences in access. And finally, values. The hierarchy of human valuation by race – the white supremacist ideology in our nation has led to inaction in the face of need of this disproportionate impact and indifference – in fact, a normalization now, I would say, in the same way that differences in infant mortality rates have been normalized or differences in diabetes rates, all of these differences in health outcomes that we see by so-called race and ethnicity, which are also – also have racism as the root cause.

Because there’s a lot of interest in health equity, I don’t have time to go into a full definition. I have a three-part definition. But I want to offer to you three principles for achieving health equity – valuing all individuals and populations equally, recognizing and rectifying historical injustices and providing resources according to need. And all of these can be operationalized in the context of COVID-19 as well as in all of our context. I have identified seven barriers to achieving health equity in our nation. They’re kind of written into our cultural or societal fabric. And so very quickly, the first of these is our narrow focus on the individual, which makes systems and structures either invisible or seemingly irrelevant. The second is our ahistorical stance.

We act as if the present were disconnected from the past and as if the current distribution of advantage and disadvantage were just a happenstance. The third is our endorsement of the myth of meritocracy, this story that goes something like this. If you work hard, you will make it. And I give you that most people who have made it have worked hard, but also – let you know that there are many other people working just as hard or harder who will never make it because of an uneven playing field which has been structured and is being perpetuated by racism and other systems of structured inequity. And to the extent that we deny racism, we blame those who haven’t made it as being lazy or stupid. The fourth is our endorsement of the myth of a zero-sum game – if you gain, I lose – which sets communities up in competition with one another and masks the cost of inequity, the fact that racism saps the strength of the whole society. The fifth is our limited future orientation.

The parts of the future that we can touch today include the children and the planet. But in this country, we have a seeming disregard for the children and a usurious relationship with the planet. The sixth is our myth of American exceptionalism, that we as a nation are so different, so special, so ordained by God that the usual rules don’t apply to us and that there’s nothing we can learn from other nations. Oh, if we had only paid a little attention to what some other nations have done during the course of the pandemic, and, oh, if we just didn’t feel that we are walled off from the rest of the nation. As Dr. Osterholm has said, what happens on the African continent with regard to vaccine distribution is going to affect us here.

And the seventh is white supremacist ideology, which I don’t lift up as a lightning-rod term but instead as the description of the false idea of a hierarchy of human valuation by race with white people at the top. There is no such hierarchy. But this underlies, you know, the dehumanization of people of color, the disregard, the inaction in the face of need and, actually, the fear of the browning of America, which underlies a lot of our political divide today but also perhaps calls to – early calls to reopen Minnesota, reopen Michigan, reopen Virginia last year. I will focus in my last very few seconds of remarks – all of these barriers to achieving health equity have manifestations during the COVID-19 pandemic. But I will focus these last remarks on the narrow focus on the individual, where I was struck as the pandemic has been rolling out and projecting into the future at least six ways that our narrow focus on the individual has hampered our efforts in control of this pandemic.

The first had to do with testing, where in this country, we have still been acting as if the COVID-19 pandemic were a medical care issue as opposed to a public health issue. The medical care approach to testing started out very early and still is largely manifest as confirming individual diagnoses for those who are symptomatic or exposed, or now those who might want to travel, whereas a public health approach includes estimating population prevalence using probability surveys and the like that include testing asymptomatic persons. Why does this matter? It matters in terms of the time delay in our understanding of what is happening with the virus because when we look at positive tests, the cases that we still report, which are positive tests of symptomatic persons, that’s a seven- to 10-day Polaroid picture delay from what is really happening on the ground. Hospitalizations represent a two- to three-week delay. Deaths represent a three- to five-week delay.

But if we were to use probability surveys, or even wastewater monitoring or whatever, we would have a better real-time estimate of what’s happening with the pandemic – a public health approach as opposed to a one-individual-by-one-individual medical care approach to testing. With regard to masking, the individual orientation – people think we’re wearing masks primarily to protect ourselves, whereas the collective orientation, you’re wearing masks to protect others. Why does it matter? It means that what we need are mask mandates right now. Mask mandates are essential to protect the health of the public in the face of widespread individual objections that there’s no virus or I don’t feel vulnerable or masks make you sick or it makes me uncomfortable, because masks are the hugest part of our toolkit right now.

We are ramping up immunizations in our toolkit, but the public health strategies, including masking, physical distancing and the like, remain our primary way of controlling this pandemic. I won’t go into detail, but the third way that I saw this was how we’re thinking about school reopenings, how we’re thinking about vaccine trial endpoints. Why don’t we know about asymptomatic spread among people who are vaccinated? The vaccine optimism, which has completely shut our eyes to the importance of maintaining public health interventions. And then how we even understand the COVID-19 death toll – surely, it’s a reflection – it’s a loss – each death represents a loss to individual families and communities, but we have not yet understood that the loss of 550,000 people represents a huge hit to the nation. So I look forward to your questions. I know I’ve just given you top-line ideas across a whole span of things. And so thank you very much.

[0:29:58]

RICK WEISS: Thank you, Camara – fantastic overview of the issues at stake here. We have a few questions coming in. I want to remind people to hover over the chat mode and – the chat or the Q&A mode? – wherever those instructions were. I’ll get clarification on that in a moment. And send your questions in. Meanwhile, I want to clarify one quick thing with you, Mike. You had talked about – I think you said something about, maybe or maybe not, we’ll have this, you know, in better shape by next summer. Did you mean summer of 2021, or are you looking ahead to summer of 2022? I wasn’t sure what you meant there.

MICHAEL OSTERHOLM: I’m talking about 2021.

RICK WEISS: Twenty-one, OK – just checking.

MICHAEL OSTERHOLM: Yep.

[0:30:39]

RICK WEISS: OK, great. OK, as we – I want to ask one question from the moderator’s position here before I start sending you some questions over from reporters, but if you could each quickly just tell me, you know, one thing that you think reporters are missing or could do better. You’ve touched on a few of them in your introductory remarks. But to make this super practical right now for reporters, one quick hit from you, Mike, and one from you, Camara, that maybe you wish was different or that you encourage reporters to focus on in the weeks ahead.

[0:31:11]

MICHAEL OSTERHOLM: You know, I think the challenge we’ve had is we’ve gone from a very politically charged discussion between science and a sense of politics, and it really got to a point of being a competition of soundbites. And I understand in media, soundbites will always be important. And I think, however – I hope we can get away from that more and really get into more in-depth in some of the stories. Just because person A says this, that will be the lead, that will be the headline, and that will be two-thirds of the body of the thing. I’d like to know more about, well, why did somebody say that? What does that mean? You know, what are the data that support that? A good example – we hear a number of experts talking about seasonality of this virus and why we’re not going to see an increase in number of cases.

Give me one shred of evidence that there’s been anything to date that has suggested seasonality to this virus. There’s been none, nothing. And yet, we will have one soundbite, and an entire story will then reflect that. So I hope that we could get more into the background and more in-depth in the data and have everyone be accountable. If I’m saying X or saying Y, what are the data behind that? Let’s support that rather than just take a prevailing norm. You know, if something gets repeated enough times today, it becomes fact. And I’ve seen that happen far too often, where it’s just one thing is repeated 30 times, and now nobody challenges it anymore because it’s fact.

[0:32:43]

RICK WEISS: Great point. And, you know, it has some parallels. It reminds me of the reporting that goes on in the lead-up to elections when we start complaining about the horserace journalism instead of talking about what the issues actually are, so another example of just getting at the roots of things instead of just the surface. And I want to clarify, yes, Q&A button for your questions, please – not the chat bar. Camara, something…

CAMARA PHYLLIS JONES: Yes.

RICK WEISS: …For the journalists.

[0:33:07]

CAMARA PHYLLIS JONES: What you need to know and what I hope you can lift up is that we have not yet in this country fully implemented public health strategies for controlling the COVID-19 pandemic. We’re getting closer to it now with the – even the 100-day mask challenge from President Biden. But if we were to look from – at other countries, if we were to look at Australia, which had a massive shutdown and all – and now, if you go to Australia, it’s like it’s some other part – it’s not part of this planet because they are living a very different life, a more free life – the one that we want to reopen to, but we are premature because we haven’t implemented the public health strategies.

So I would say that we should not be so vaccine optimistic that we continue to neglect or not even lift up public health strategies, which include in other nations paying people to stay at home, making it feasible for as many people as possible to shut down, to stay at home. It doesn’t mean that businesses – that, you know, that we shut down the economy, but that we use the money. So we’re starting to do that in the American Rescue Plan and the like. But when you have states like Texas and Mississippi and now all of the ones who are feeling that we are at the end of this, that’s the other part of the story.

The first part is let’s do public health strong and right, even as we’re putting the vaccine – getting that into arms. The second is that what happens in Texas affects the rest of the nation. What happens – we cannot wall ourselves off. The virus has one job – to reproduce itself. It will try to find every available vulnerable host. We affect the availability with public health strategies, hiding ourselves from the virus. We affect the vulnerability with individual-by-individual vaccinations. We need to do both.

[0:34:54]

RICK WEISS: Fantastic. Thank you both. We’ll get into some questions now from reporters – again, the Q&A mode for asking those questions. This is to Dr. Osterholm for starters. Do you think aerosol – and, I’m sorry, from Tina Saey at Science News – do you think aerosol scientists can come to a consensus with epidemiologists and virologists about whether SARS-CoV-2 qualifies as an airborne virus, and what makes you think that? And is it – is this just a question about labeling, or is this a question the answer to which makes a difference in how we deal with it?

[0:35:27]

MICHAEL OSTERHOLM: Well, first of all, let me just start out by saying this is a very important question and, frankly, a frustrating one for me. I’m an epidemiologist. I’m not an aerobiologist, not an industrial hygienist. I work with individuals in these areas. I think the data are clear and compelling that this is an airborne disease. Aerosols play a very important role in this. And if you look at the literature and what we now have showing that, that’s been very clear. I think the challenge has come from a traditional infection control standpoint and what this would mean that infection control would need to do in hospitals, health care facilities, et cetera, to actually reduce risk, meaning that a respirator – an N95 respirator – really is required.

You know, we have had an abundance of data showing that, for example, face masks, as we call face cloth coverings, have leakage of 50% to 60% in and out of 1-nanometer particles. And they’re not tight face-fitting, et cetera. That’s where, in fact, aerosols can play a key role. And so while I surely believe that you could use what – should use whatever kind of protection you can put in front of your face, knowing that it’s all still all about dose and time, if you can reduce the dose by a third or a half for a period of time, that gives you more protection. But in the end, aerosols are really that critical. And it’s unfortunate we continue to have this debate when I think that the body of sciences is very clear and compelling on this one.

[0:37:01]

RICK WEISS: Camara, I wonder if you can answer a question about people’s views about front-line workers, which are, as you mentioned, so often people of color, minority workers, and whether maybe attitudes towards these people have improved as a result of the situation that we’re in today, with more respect, more sympathy for the people who are putting their lives at risk to serve Americans in various places in today’s economy.

[0:37:29]

CAMARA PHYLLIS JONES: Well, sympathy and empathy are all important, but what we need are protections (laughter), you know? So we need – we actually – we need the invocation – and these things are coming on board soon, but we need the invocation of the Defense Production Act to produce more personal protective equipment, including N95 masks, for people – you know, for the teachers and the kids and all of them, but the people in the warehouses and meatpacking plants and the like. We need more testing, you know, with the Defense Production Act. We need more real protections. So I think that the people that we call essential workers, front-line workers, have also been treated and are still being treated possibly as disposable.

When the phases of the – you know, the – so the Advisory Committee on Immunization Practices by CDC on Phase 1a, which was, you know, hospital, health care workers and people in long-term care facilities, by which they meant nursing homes and the like. They did not include prisons and jails and detention centers as long-term care facilities. But then Phase 1b was 75-plus and other essential workers, including teachers and factory workers and bus drivers, transportation and all of that. And then Phase 1c was supposed to be 65 up and then people with other preexisting conditions. That phasing actually recognized that there are different kinds of risk. There’s structural risk, and there’s individual risk. Structural risk includes increased exposure either where you work or where you live. So Phase 1a were people who were at increased risk from exposure at work, health care facilities or where they lived – long-term care facilities. But as I said, they didn’t include everybody at increased exposure from work. They didn’t include the other essential workers until 1b or the people in prisons and the like, which I haven’t heard people talking about them at all. The other kind of risk, individual risk, is increased vulnerability – individual vulnerability – because of age or because of preexisting health conditions. In Georgia, the 65-plus, which was supposed to be Phase 1c, got glommed into Phase 1a-plus, eclipsing all of the people, the other front-line workers who were at structural risk because they were the ones delivering the food, stocking the shelves and all so that the rest of us could safely shelter in place, hide at home and do our work through Zoom, right?

That is not honoring people. That is not respecting people. That is still – that is another reflection – so that’s going to be No. 7 – of how we are so narrowly focused on the individual, we don’t even recognize structural risk. We don’t understand that the reason that nine times as many Black and brown people in the age group – I don’t have the exact, but look it up – 35 to maybe 54 – the deaths from COVID-19 in that young age group is perhaps nine times for Black and brown people as for white people. That’s because these are the people who are doing these front-line, essential jobs so that other people can hide in place. So I think that if we were really going to honor front-line workers, then we would recognize that they were increased structural risk and we would not let people who were successfully hiding at home, even though they are at increased individual risk. But, you know, we already got the ones who are in the nursing homes. We would’ve vaccinated them first. I think we need to vaccinate all teachers right now and all the rest of them.

[0:41:10]

RICK WEISS: Thank you. Question here for you, Dr. Osterholm, at least for starters, from David Holzman, who’s a freelancer in Lexington, Mass. Can you please talk more about COVID-19 infections among schoolchildren? What are your thoughts on the new guidance? I think we got a hint of that, but you can unpack that a bit. Are there…

MICHAEL OSTERHOLM: Yeah.

RICK WEISS: Very interesting that policies – that practices seem to be weeks behind what the science says. Are there studies that you recommend journalists look at about this topic? And what’s the most responsible way for journalists today to report on COVID-19 infection among schoolchildren?

[0:41:48]

MICHAEL OSTERHOLM: Well, I think this is one where, again, the situational awareness is everything. And what I mean by that is that for a number of months, we struggled in this country to describe what was happening with school-age children in terms of transmission, in part because schools had been closed, they were doing distance learning and they weren’t in the classroom so that we could, in fact, identify what those risks might be, what the issues are around prevention of transmission. As time went on, though, and more schools did open up, it became very clear that there was something very unique about children, particularly those roughly eighth grade and younger, where we saw very little transmission. It was not at all consistent with what we saw in the older-age population. We didn’t see transmission between kids, kids and their families, kids and teachers, teachers to kids – not that it hadn’t occurred, but not anywhere close to the level that we saw.

So I was actually one of those very strong proponents saying, I think you can open schools safely relative to, for example, a given year of influenza. We don’t close schools down when we lose, you know, a number of children each year in schools due to influenza infection. And so I was on board. The variants completely changed that. B.1.1.7 first was identified in England, largely out of a country that was in lockdown for another of the COVID-19 viruses, and yet cases continued to occur and increase and primarily in young kids. That was how they discovered B.1.1.7 – by actually identifying those viruses, sequencing them and found, oh, my; look what’s happening in children. Well, that’s been borne out through Europe that kids have now played a major role in the transmission of B.1.1.7. Right here in the United States, we’re seeing that. Our state of Minnesota has a very large and rapidly growing outbreak right now of B.1.1.7 that were initially focused in youth sports, transmitted widely in kids in a number of different areas, now spilling over into parents, grandparents and so forth. It’s a totally different virus in the sense of what it’s doing epidemiologically. So here we are now putting out new guidance today based on the conditions of four or five months ago, when, in fact, today, I think the ability to transmit this virus in our communities is greatly enhanced in schools.

And remember, I’m the one that said months ago, open the schools. So I think this is one of the challenges we have is we are so slow on the uptake to deal with situational awareness and changes, just like when the variants arrived in November. You know, the same thing was it was people were slow to understand the implications. So I think school openings today are going to greatly enhance transmission of B.1.1.7 in our communities, and I predict that within weeks, we will be revisiting this issue, unfortunately after we’ve had substantial transmission.

[0:44:48]

RICK WEISS: OK. Question here for you, Camara, from Bara Vaida, who’s a freelancer from Washington, D.C. Can you talk more about the issue of vaccine hesitancy and that journalists aren’t focused enough on the access and structural challenges for communities of color to access the vaccine? How should journalists write about this issue?

[0:45:11]

CAMARA PHYLLIS JONES: Well, the first thing is to acknowledge that vaccine hesitancy is not restricted to Black and brown communities, and I think there’s been more journalism on that recently. But the first study that I saw about this, the Kaiser Family Foundation, a few months ago, 35% of African Americans said they would wait to see the vaccine. But even at that time, I believe the numbers were 42% of people in rural areas and 42% of Republicans. So the fact that people sort of honed in on the African American hesitancy – surely the African American hesitancy is well-placed because why should you trust an institution that has not shown itself to be trustworthy historically? But even then, it was less than the hesitancy in other groups. So that is what I meant when I said that we are so focused we don’t even – the story wasn’t there (laughter). You know, the story wasn’t there, but the attribution was there because we, again, focus on the individual.

And this fact that if we’re going to start rolling out the vaccine in pharmacies, you need to acknowledge that there are pharmacy deserts. You know, if you’re going to put it in – you know, have mass vaccination sites out in Foxborough, Mass., you have to say, well, who can get there? So what we have to do is we have to understand the existence – the narrow focus on the individual makes systems and structures either invisible or irrelevant. Racism is a system, and it structures opportunity (ph) – you know, structures in terms of how we’re rolling out the vaccine. We need to step back from an individual view and say, even if you don’t see what the systems are because they haven’t been highlighted before, say what could be in place here? The view should be, how could – my first question could be, what are the constraints?

If people are not making good decisions, what choices do they have – right? – what information? So I would say that for journalists to reframe and to always be asking what is the structure and system in the story first before they get to the individuals. I know individual stories sell. I’m not a journalist. But the important questions are what are the structural manifestations? What is playing here? Who has what power?

[0:47:38]

RICK WEISS: Well, great, great answer and a great reminder for reporters. You know, I think as a former science reporter myself, on a science health story, the feeling is always to go to a scientist. And we forget that there are social scientists out there who are scientists and have a lot to say on these issues. It’s very…

[0:47:57]

CAMARA PHYLLIS JONES: Well, I’m not a social scientist. I’m a physician and an epidemiologist. But, yes, there are those. But I actually came to this, which some people might think of as social science, from the point of view of being a physician epidemiologist.

[0:48:10]

RICK WEISS: Great. OK. Thank you. Question here from Jim Morelli, Fox 25 in Boston, for Dr. Osterholm. We keep getting assurances from Pfizer, Moderna, J&J of the effectiveness of their vaccines against the variants. I’ve heard others in health care say this as well. Do we actually know whether the vaccines are effective against the variants?

MICHAEL OSTERHOLM: Oh, that’s a really critical question, one that we obviously have to answer as we go through time with the variants arriving and certain variants becoming dominant. At this point, the variant that really is front and center, at least in the United States and Europe, is this B.1.1.7. We surely have the B.1.351, the South African variant. I hate using that term since it’s often seen as pejorative to the country of origin. But if we look at that one or P.1, the variant that was first found in Brazil, those are here but not circulating widely. So the concern we would have in the United States would be B.1.1.7.

And in that case, we are able to report that it is a very high level of protection against that variant. There’s no evidence that there’s any challenge there. But globally, this is where it gets more difficult, where we see these particular variants that actually have the mutation 484K. That is the one that interferes in terms of how well the antibody induced from the vaccine works. So at this point, trust the vaccines in this country as they are. If we’re in another country where we see high levels of a variant circulating that has this particular mutation, we’ve got to reconsider that. The data we do have are from clinical trials that were held in different parts of the world, South Africa and South America, and neither the Pfizer or Moderna vaccines were evaluated there. So it’s been difficult to compare what they might look like in the face of these other variants, as opposed to what either AstraZeneca’s or Johnson & Johnson’s vaccines did.

[0:50:23]

CAMARA PHYLLIS JONES: I’d like to pick up on that, too, to say that the implications going forward are that we can’t wait and hope that other parts of the world get the vaccine. I know right now in North America, now we’re sharing our AstraZeneca with Canada and Mexico. But the whole issue of intellectual property rights and waiving those – that have been raised by India and South Africa to the World Trade Organization, where the United States has been in opposition to waiving the intellectual property rights in relation to COVID-19 vaccines. I think we need to think about that because there are some countries on the African continent and in Asia and elsewhere who are thinking they may not even get vaccine until 2022. The more the virus spreads, each time it spreads, it can change. And this is how the variants rise up, you know, is through mutations. If we don’t want to think about it as waiving intellectual property rights, let’s think about it as partnerships.

You know, we have the Johnson & Johnson-Merck partnership that was brokered by the president. Well, maybe we can have partnerships because it’s like the recipe. There are companies around the world that can create the vaccine, but they would want the recipe. So let’s have a partnership between Pfizer-BioNTech or Moderna or the others with these other companies so that we can start manufacturing the vaccine in many places around the world and disseminating it from those places because even if we think we’re fine now with the so-called U.K. variant, B.1.1.7, you know, and we think that we get all our people vaccinated, say, by June or July, if the rest of the world – if the virus is raging around the rest of the world, we will not be protected. So it is not only magnanimous, it is in our own self-interest to make sure that there is kind of an even distribution of the vaccine as we also continue to do our public health strategies of – I don’t even want to go there – hiding in place and masking and all that. But we need to be concerned about that, too. So whether we say, OK, it’s OK to waive the intellectual property rights, or whether we describe it as partnerships or whatever, we need to get vaccine everywhere around the world.

[0:52:50]

RICK WEISS: Here’s a question for both of you from Vincent Gabrielle at Knoxville News Sentinel. And basically, I’m going to shorten this a little bit, but right now posing the situation that we’re in a situation where we can either eradicate COVID-19 with strong public health approaches or find ourselves facing a new, fresh, episodic epidemic or pandemic. And can you each describe your best- and worst-case scenarios? What – how might we end up in a good place? What’s the bad place you could see us ending up in if we don’t play our cards right? And, Mike, I’ll start with you.

MICHAEL OSTERHOLM: Well, first of all, we can’t eradicate this virus, and I say that because we already have evidence that there are animals, populations that have been infected by this virus, suggesting there surely are more, meaning I’m not talking about the animal from which this virus likely emerged from, but we’ve already had examples of dogs and cats and ferrets and mink, gorillas. This virus has surely been able to become what we call a zoonotic disease, a virus transmitted to and by humans and animals to each other. And so that is one of the hallmark qualities of a disease that can be eradicated is it can’t have any other natural reservoir than humans itself. Now, how much animal infection occurs? We don’t know, but it’s there. I do think that at this point, the variants are going to drive a great deal of how we ultimately will deal with this virus.

And if we can get an effective vaccine, maybe a second- or even third-generation vaccine that is also highly effective against the variants, we may find that we can have major control over this transmission, much like other vaccine-preventable diseases. Otherwise, will it become a seasonal, quote-unquote, “flu-like” virus like the other coronaviruses have become the cold-causing coronaviruses? Possibly. I think this is also one where we just have to, again, be very humble and say we’re not sure yet. We don’t know. I would not bet against this virus in terms of it going away, but then I don’t want to bet against humans in terms of finding the ingenuity to control its transmission. And I think, as Camara just said, it is more than just science. It’s a commitment. It’s a vision for this. And so I think the ability to control this virus will in part be, how good are we able to deal with it in the low- and middle-income countries?

[0:55:28]

CAMARA PHYLLIS JONES: So my best-case scenario – my best-case scenario a few months ago was that I knew I was going to be wearing my mask through December, but I thought maybe coming into the spring of 2022 that we would be out of it because I thought that we would implement more successfully our public health strategies. We’re starting to do that in this country today. If we shut down across the nation for eight weeks, we would be in great shape to then – and continue to vaccinate, we would be in great shape. People are so happy because the fourth wave, the numbers are coming down, right? But they’re still above the height of what we were really concerned about in the summer of 2020.

People – it’s just sort of like we do not understand exponential spread, right? We do not understand that the virus has one job. We do not understand that we cannot segment off states or parts of cities or anything. And there is this notion of individual freedom, or it’s business, versus lives. And we don’t value the lives that we think are being disproportionately impacted, so we want to open up business. There are a lot of value-laden decisions being made now, and we are not being guided in the States by science. And so what we need to do is maybe, from the federal government, say that is not just a 100-day mask challenge and not just masking, you know, in workplaces, which may work its way through, or masking on federal property. We really, if we want to save lives, need to shut down for six to eight weeks.

If we shut down for six to eight weeks, if we made – if we paid people to stay in place, except for those who are absolutely necessary to keep the society running, and then if we protected them, if OSHA had guidelines that could protect workplaces and we had PPE that could protect workers, we could actually tamp down this fire and then gently let up. But if we tamp down in one place, but it’s raging someplace else, it’s going to spread. We need to do something in a very solid, coordinated way, and we could be – and then Labor Day, we could take – all of us could take September as a holiday.

[0:58:26]

RICK WEISS: (Laughter) Wow. Some tough love needed there. We’ll see whether the nation is up for it. I wish we could keep going. We’re just about out of time here. I do want to come back to each of you for just a half a minute each and give our reporters on the line here a take-home message or one last thought that you want to leave them with. Mike, I’ll start with you.

CAMARA PHYLLIS JONES: OK, Mike.

MICHAEL OSTERHOLM: OK. Well, the first thing I would say – as a reporter, make sure that all your sources back up their general statements or conclusions with data. And if they don’t have data, which may be the case, then at least how did they come upon that conclusion? And be able to refine that. Again, I think we’re doing far too much reporting in this country by soundbites, where somebody has been given an authority position to be able to say X, and then that becomes the story without challenging it. And I thought the question just now about the aerosols is a good example of that. You know, I gave my point of view, but if we were in a more extensive interview, ask me for what are my databases, what are my sources, how does that support the point I made? And I think that would be very helpful right now because I think that’s been a weak point in reporting is the accepting of, quote-unquote, “experts’” comments without really trying to understand what data supports those.

[0:59:45]

RICK WEISS: Thanks. And you’re talking my language. People who know me know that I often say the most important question a reporter can ever ask is, how do you know that? And it goes even if you’re talking to the biggest expert in the world, it’s the right question to ask. Camara, from you.

[1:00:01]

CAMARA PHYLLIS JONES: Yes. So I guess my closing thought is that we have seen how deadly COVID denial is – has been for this nation, that we’re one-twentieth of the world population but have experienced one-fifth of the world’s deaths largely because of denial that there was a real problem. And I would say that what you need to also understand is that racism denial is equally deadly. And so what we need to do is to name racism, be unafraid to say the whole word, to ask how is racism operating here, and then to organize and strategize to act. And the linkage between how opportunity was structured, and value aside (ph), that’s manifesting as disproportionate impact of COVID-19 on communities of color, that’s the intersection, really. We’re seeing those excess deaths at the intersection of COVID denial and racism denial, and we need to stop denying both of those and act.

[1:01:02]

RICK WEISS: I want to thank both of our guests today for just a super interesting and thoughtful and helpful, I think, in-practical-terms-for-reporters discussion. Thank you so much for doing that. For those of you on the line and wrapping up now, first, I want to ask the reporters, as you log off today, you will get a prompt for a very short three-question survey. I’d be so grateful if you would just take a half-minute to answer those questions. It helps us do better as we plan future media briefings. I encourage all of you to visit our website, sciline.org, just recently refreshed, as I mentioned – very easy to find all the things that we can do for you. Everything we do is free and philanthropically supported. And finally, do follow us on Twitter to stay abreast of all the things we’re doing – @RealSciLine. Thank you, Dr. Camara Phyllis Jones, Dr. Michael Osterholm, for a really interesting media briefing today.

MICHAEL OSTERHOLM: Thank you.

RICK WEISS: Bye-bye.