From the beginning, the University of Washington and UW Medicine have supported our state’s efforts to mitigate the effects of COVID-19. “Huskies fighting COVID-19” is a feature series highlighting individuals who’s work is making an impact from Public Health and Computer Science & Engineering to the Virology Lab and the emergency room.
This week we connected with Hilary Godwin, Dean of the University of Washington School of Public Health and professor in the Department of Environmental & Occupational Health Sciences. She shares her insight on understanding the impact of lagging data, connecting with others safely during the pandemic and preparing for upcoming challenges as we look to 2021.
Q: We keep hearing in the news about case counts going up, particularly among young people. What do you think it will take to get the virus under control enough for counties to continue the reopening process?
A: I think that, to be able to continue the reopening process safely, we will need much broader adoption of social distancing and face-covering guidelines than we currently have. I tend to think of it this way: we have enough public health and healthcare infrastructure to be able to handle a certain number of cases at any given time (without having the number of cases surge out of control) and that basically means that we as a community can tolerate a certain amount of exposure/transmission risk. I think that our top priorities as a society should be to use that “quota” of transmission risk in a way that allows us to open critical segments of the economy and, ideally, to open K-12 schools. What we learned from our early attempts at re-opening (and the resulting uptick in cases) is that doesn’t leave a lot of bandwidth (in terms of transmission risk) for activities that may bring us joy but are not essential, unless we want to risk a new surge in cases. Although “opening schools before bars” may seem like a no-brainer, this is a hard reality for many people to accept, particularly when we may be looking at trying to contain this pandemic for another year or two.
Q: Has the emergence and continuation of the COVID-19 pandemic changed or affirmed how you think about the Public Health field? If so, in what ways?
A: The COVID-19 pandemic has definitely reinforced to me the importance of investing in prevention and making decisions based on data, both of which are core tenets of public health. The pandemic has also really highlighted the need to address social inequities and injustices that are pervasive in our society, including racism, as these are primary sources of the health disparities we see in our country. I have also found the pandemic to be humbling: we in public health need to do a better job of communicating consistently and clearly to policy makers and the public in general; we also need to develop better mechanisms for coordinating with each other and with other stakeholders both nationally and globally.
Q: What is one thing you wish more policymakers understood about the pandemic?
A: I wish more policymakers understood how data lags impact our ability to control the pandemic. There is a significant lag between when a person gets infected and when they show up as a case, and even greater lags for hospitalizations and deaths. Some of this has to do with access to testing and testing capacity, but a lot of it also has to do with the natural timeline for disease progression for COVID-19. These lags mean that by the time we know we have a problem, we are already a couple of weeks behind (and the problem has most likely be growing exponentially during that time). That means that we are inherently trying to make our best educated guess about how the pandemic is trending so that we can take action proactively before things get out of control. That’s a very hard concept for a lot of folks to grasp. People often would like to wait to be “sure” that action is needed, but by then, it may be that much harder to get the pandemic back under control.
Q: The COVID-19 pandemic has changed how our communities work, eat, play and socialize. Do you have any tips for folks who may find themselves struggling to find connection while following public health guidelines?
A: My husband and I have this conversation all the time: he is more social than I am (I am more of an introvert) and really misses socializing with other people. We also both miss spending time with family, who are all out of town for us. We have implemented weekly Zoom calls with my extended family as one way to cope with not being able to travel to see each other.
For getting together with friends and family that live nearby, I recommend what I call the “Fauci rules” (see this story in the Washington Post): if you get together with people, limit the number of people from outside your household, get together outdoors, maintain 6 foot separation and wear masks (other than when you are eating). If it’s too hot or rainy, then reschedule for another day.
This works now, because we have relatively good weather, but is going to be harder when things get colder. One strategy to consider as we head into the fall and the spring is to form a “pod” with another household that shares your level of commitment to social distancing and agree that both families will forgo interactions with other people so that you can spend time indoors with each other. (This is also a possible strategy for families that want to share childcare and remote school support for their kids.)
Q: When you look into next year and beyond, what challenges do you foresee for our communities as we navigate milestones like vaccine distribution once one becomes available? How can we ensure we navigate these challenges in a way that is equitable to all?
A: I was talking with a friend today who expressed that he can’t wait for 2020 to be over. I think most of us would agree with that sentiment!
One challenge that I foresee is that we haven’t been talking enough (or honestly enough) about what 2021 is likely to look like and how we should be planning for that reality. Because we likely won’t have large numbers of doses of vaccines until mid-2021 at the earliest, and it will likely take months to get those vaccine doses broadly distributed, much of 2021 is likely to look and feel a lot like the last five months have looked.
I anticipate that we will continue experience local surges in cases as we reopen different segments of the economy throughout 2021 and that will mean short-term returns to more restrictive measures to bring those surges under control. I also anticipate that we will continue to experience supply chain issues for testing reagents and supplies and that we will see something similar happen in the realm of vaccines. Because we have never mounted such a large scale vaccine campaign, I anticipate coordination will be challenging, particularly across state lines and globally. We also have a history of vaccine hesitancy in this country that will likely further complicate any vaccine campaigns.
I do think that, the timing is right to collectively lift our gaze up from the chaos of the moment and think constructively about what we can do to better prepare ourselves, our organizations and our communities for the upcoming year. Within my organization, we are having conversations about how we can best support each other in the upcoming year given this reality. I am particularly concerned about how we support our employees who have young children at home and are juggling working, parenting and teaching their kids. This means being flexible both in terms of schedules and in terms of expectations. On a societal level, I am particularly concerned that we continue to maintain the social safeguards that were implemented early in the pandemic (e.g., eviction moratoriums and unemployment benefits) and that we make sure that we are making critical services (including testing and vaccine) broadly available (and ideally free of charge). Finally, we need to make sure that, in the midst of the COVID crisis, we don’t lose sight of the importance of addressing racism and other social injustices now, so that we can emerge from this pandemic stronger and better as a society. We have a lot of work in front of us.