A sketch of four doctors in each corner. In the center is a stethoscope. They talk about Covid-19 lessons.
An illustration of Dr. Bob Wachter, Katelyn Jetelina, Dr. Mark Smith and Dr. Carlos del Rio. Illustration by Molly Oleson.

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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.

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REPORTER. Annika Hom is our inequality reporter through our partnership with Report for America. Annika was born and raised in the Bay Area. She previously interned at SF Weekly and the Boston Globe where she focused on local news and immigration. She is a proud Chinese and Filipina American. She has a twin brother that (contrary to soap opera tropes) is not evil.

Follow her on Twitter at @AnnikaHom.

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  1. We can disagree about many things regarding the lockdown policies adopted, proposed, etc. in response to the COVID 19 pandemic. For example, I am incandescently incensed by the shutting down of schools for so long and listening to folks say “Oops, maybe we got that one wrong” is hard to take as a step in the right direction. I am working on it… But can we all agree that the freaking CERTAINTY with which folks expressed the efficacy and wisdom of pursuing never before tried, or properly assessed, interventions did an enormous disservice to everyone? I have the same criticism for those expressing that very same CERTAINTY of the opposite. Perhaps, it would have been ok if any and all criticism of restrictive lockdown policies had not been branded as satanic, and unreasonable and all folks expressing them shut down as not just wrong but dangerous, stupid, and monstrous. We should have had a debate and listened to a variety of views from a variety of sources. No one was 100% correct about everything and public policies require the weighing of benefits and deficits. Let’s not shut folks down in the future and just call them names. Let’s engage with the facts and the arguments. I am old but calling people names rather than engaging in arguments used to be a dead certain sign that they had no arguments and were trying to bully rather than persuade. These days, name calling seems to be where most energy is spent. I wonder why? (and for the inevitable responses here, please give me the respect to call me something new and original. The name callers have very limited imaginations these days.)

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  2. The pandemic is NOT over. And UCSF hardline anti-mask stance (personified by nut-jobs Monica Gandhi and Peter Chin-Hong) just exacerbated it.

    And Jetelina is wrong about transmission being “low” – it’s just that nearly all the most reliable resources simply stopped counting. We were at 1,000 US deaths-per-week when the state-of-emergency ended and the CDC went radio-silent (https://peoplescdc.substack.com/p/peoples-cdc-covid-19-weather-report-a4e ); and that’s not even counting the thousands more currently immobile due to Long COVID… and people wonder why there’s a labour shortage?

    Bring back all the safety measures to save lives.
    Mask up 😷 Space out ↔️ Get vaxxed 💉 Get boosted 💉

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    1. Thank you for staying the errors in their logic. I am Immune compromised and can’t have any contact, because we pretend Covid is not an issue . We have no mitigation measures anywhere that I need or want to go. I can’t safety get life saving or medically treatment because medical facilities don’t feel like taking precautions. Now we are even debating that Covid used to a big issue. We seem to have forgot the images of body bags in trucks. I get that my life (and millions of others) are not considered worth saving. But I wish we would at least come out and say it : 1. We don’t care about anyone who may be vulnerable to severe disease or death from Covid. 2. We don’t feel like doing anything about it. AND 3. We also don’t care about long covid, or post covid sudden death or cardiac events which everyone is subject to.

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  3. I think the best sentence in this article is: “The disease spread more in multi-generational households and among essential workers, issues tied more to economic inequality and dense living situations.”

    Meanwhile, the uber-wealthy (disproportionately white men, their trophy wives, and kids with laptops?) escaped to the hills or wined and dined in their exclusive parklets while the hoi polloi jammed buses and sidewalks.

    From the beginning of the pandemic, fear, ignorance and self-interests made the disease worse than it may have been.

    Through strict lockdowns and contact tracing, and without our vaccines, China successfully mitigated the disease to about 5,000 deaths in a country of about one-and-a-half billion. For most there, life almost returned to normal.

    When the West saw its supply chains of Chinese imports failing, it threatened to pull out its Chinese factories and investments. That is when China aborted its austerity measures to see a million people die almost immediately– a number not dissimilar to the number of people who had died up to that time in the United States.

    While we might pride ourselves in having 20/20 hindsight, can we now see how the disease lingers, evolves, and continues to spread among us and the children with unknown repercussions?

    Since May, our government has virtually ceased monitoring and mitigating the disease as it claws back health funding for… other projects. Had we ever worn glasses, it threw them away.

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