Dr. Ashish Jha, the director of Harvard’s Global Health Institute, does some 20 to 25 interviews a day on health policy. In this week’s UCSF Grand Rounds with Dr. Bob Wachter, Jha dug into the nuances of publicly discussing the pandemic, the nation’s shortcomings in response to the coronavirus, and what the United States needs to do moving forward.
The politicization of U.S. policy on the virus has made Jha’s interviews difficult, with certain interviewers wanting to get “deeply political” in the framing of their questions. That’s not useful, Jha said.
When Wachter asked where to draw the line with politics, as COVID-19 has undoubtedly become a political issue, Jha’s response was simple: “I think about where and how do I be constructive,” he said. His single biggest goal in these interviews is not to spread misinformation.
Jha acknowledged his own “embarrassing” predictions about the coronavirus back in late January, when he wrote that “that the U.S. was going to be a standout” in its response. In late February, he “realized I had gotten this all wrong, and that things were probably quite bad in many parts of the country. But we had no idea. We had no testing. We had no capacity to do so. We weren’t doing the right surveillance,” Jha said.
How did the Harvard expert manage to miss what was happening? Optimism, anchoring bias, and “a strong belief in the terrific team at the CDC,” the Centers for Disease Control, he said. “It takes a lot of information for you to decide that everything you’ve believed about that is wrong,”
America’s biggest differentiating factor in its failure to respond to COVID has been one thing, Jha said: half-hearted measures. “It isn’t like there’s a single formula on public health response that’s been useful,” Jha said, describing countries that have been successful with testing, contact tracing, and aggressive lockdowns. “You can try any one of these things, but you’ve got to try and do something well.”
One country individuals eager to reopen often discuss is Sweden, which never shut down. The country had an aggressive public health campaign, telling Swedes to avoid large gatherings. Although it suffered higher death tolls compared to its Nordic neighbors and has a “beaten up economy,” it is now doing “reasonably better.” However, half of households in Sweden consist of one person, a natural formula for social distancing.
In terms of the United States, the politicalization of the issue has affected two critical arenas: expanding testing and reopening schools.
“There really was a huge hesitancy on the part of the White House to make testing capacity available,” Jha said, incredulously discussing how hospitals were told not to run PCR tests. As precious time to build up testing infrastructure was wasted, the virus spread across the country, largely undetected. Today, the U.S. is running fewer tests than it was two weeks ago, because the testing infrastructure is “buckling under pressure,” Jha said.
Without federal support, states are banding together to incentivize companies to produce new tests, some less sensitive than PCR tests, to expand testing capacity and catch more sick people earlier.
And now, parents, educators and children are preparing for both remote and in-person classes — and which option each school takes is often political. Jha said this politicization occurred when Trump said to open schools and several schools followed suit, declaring that they would open no matter what. Jha said that schools only have one shot when deciding to reopen or remain remote, noting that if a school opens too early and experiences an outbreak, it will be a long time before parents trust the school to protect their children’s best interests.
Depending on the situation, he is not against reopening some schools. On Thursday, he tweeted about reopening schools in New York where the positivity rate is one percent — and received significant backlash for being “a Trumpist.”
“There are times when I feel like I’m a darling of the left, and there are times I feel like I’m hated by the left or whoever,” Jha said, laughing off the notion of being a Trumpist. “I don’t really make it a mystery, but people see the pandemic through the lens of ‘Are you on my team, or on the other team?’ And I find that so frustrating, because, like, I’m just trying to get it right.”
Jha said that to reopen, cities must bring virus levels under control and schools must be creative about where they can teach (outdoors, in big gyms, opening windows). They should have as much in-person teaching when safe as possible. BIPOC and low-income students, as well as women who will be bearing the burden of childcare and schooling, will experience the greatest consequences from the decision for remote learning, Jha said.
Jha said he is “very optimistic” that many vaccines will be available in 2021, though he did note concerns that people will refuse to get vaccinated or that supply chain shortages will make ramping up production difficult.
Still, he sees healthcare workers getting vaccinated between December and February, and the general population in late winter, early spring.
To finish out the conversation, Wachter asked Jha, a former UCSF resident, if he had any advice for those freshly minted in medicine. His answer felt universal. Finding your own touchstones and figuring out how to use them in moments of crisis will help you get through the times when nothing feels stable, Jha said.
Read our previous Grand Rounds coverage here.