If we wound the clock back to the early 2020 Covid-19 pandemic, what would some doctors do over? School and economic guidance, for two.
At Thursday’s latest University of California, San Francisco, Grand Rounds panel, doctors discussed what the medical community got wrong during the unprecedented global pandemic.
Hindsight is 20/20. Epidemiologist and data scientist Katelyn Jetelina hesitated to condemn closing schools pre-vaccinations. Most of the time, diseases are worse for children, leading scientists to assume — incorrectly — that Covid-19 would be the same.
“That is abnormal,” Jetelina said. “We thought — and were wrong — that schools accelerate transmission in a community. But rather, they just reflected community transmission; they didn’t become vectors.”
Jetelina said if given a mulligan, schools should have been given more resources, like ventilators, masks and contact-tracing.
Dr. Carlos del Rio, interim dean at Emory University School of Medicine, said public health experts didn’t foresee the effect of learning loss and isolationism on students. That impact could be the most long-lasting, UCSF professor of medicine Dr. Mark Smith said.
“One of the things that we got wrong is the schools,” Del Rio said. “And we hope we don’t make this mistake again.”
Panelists were most worried about how science was communicated. Distrust in health institutions like the U.S. Centers Disease for Control and Prevention and doctors were at an all-time high — and along clear partisan lines.
“I’m very concerned we’re not training public health scientists [to take] disinformation seriously,” Jetelina said.
Public policy messaging, particularly that health was valued over businesses, was a misstep, del Rio added; instead, “the reality is we need strong public health in order for the economy to be successful.”
While panelists celebrated gains in data, data visualization and science fueled by the pandemic, they worried that a lack of a coordinated data and healthcare system set up the nation for another disaster.
Del Rio said at present, the healthcare system is still incapable of dealing with such high demand. In Atlanta, Georgia, where he works, the emergency department is short 20 to 30 beds daily.
Race as a factor
Also top of mind was how race played a factor. Smith and del Rio kicked off the panel bemoaning the U.S. Supreme Court’s decision, delivered earlier that day, which which forbids colleges and universities from using race in admissions.
Smith called the decision “horrible,” and noted he was a direct beneficiary of affirmative action at two schools at the heart of the decision, Harvard University and the University of North Carolina.
“We need to understand: Structural racism is a major cancer in our society,” del Rio said. “It kills people.”
That was evidenced in the pandemic when, in the beginning, Black and Latinx people died from Covid-19 at disproportionately higher rates.
At first, the media blamed Covid-19’s racial health inequities on pre-existing health disparities Black people face, like higher rates of diabetes and hypertension, but “that wasn’t entirely true,” Smith said.
The disease spread more in multi-generational households and among essential workers, issues tied more to economic inequality and dense living situations.
Dr. Bob Wachter, the moderator of the panel and chair of UCSF’s Department of Medicine, asked if the Black Lives Matters movement, which coincided the summer of 2020 following the police killing of George Floyd deepened racial pandemic impacts.
Smith agreed. The pandemic and fear of police brutality “worked together.”
What precautions should we take now?
But in other ways, Covid-19 in 2023 is not Covid-19 of 2020, largely thanks to higher vaccination rates. All three panelists encourage boosting, but noted just 16 percent of Americans and 40 percent of Americans 65 and older received their third booster.
It’s unclear if experts will recommend an annual Covid-19 booster in the future, similar to the flu, or to recommend it seasonally. It’s also unknown if covid will surge three or four times a year, or spread seasonally. Wachter said the last major surge seen was in January 2022.
For this reason, as well as higher immunity, the panelists are less strict about many precautions including masking. When surges arise or risks are higher, they tighten up again.
But “today, transmission is incredibly low,” Jetelina said.