“The Thanksgiving Increase [in Covid cases] will turn into a Christmas and a New Year increase, “says Dr. Ellie Murray, an epidemiologist at Boston University. “The current wave we’re in may not peak until sometime – maybe – February.”
At Boston University, Murray heads the Epidemiology Department’s Causal Lab, which focuses on improving and expanding the use of evidence-based decision-making in everyday life. With Thanksgiving ahead of us and the Christmas season on the doorstep, she wants people to pause and take the time to speak with their families and loved ones about the Covid-related decisions they are making in their own lives.
How does an epidemiologist think about these decisions? And what exactly do we see each other in the coming weeks and months? To discuss this, POLITICO Magazine spoke to Murray. A condensed transcript of this conversation is listed below and edited for length and clarity.
Regarding the coronavirus, given the surge in cases and widespread Thanksgiving travel – and the incubation period for the virus – what to expect in two or three weeks?
Right now, cases are trending, hospitalizations are trending, and deaths are trending in most parts of the United States. This is a really bad situation to go on vacation.
I’ve seen people say things like, “We just have to go through the next week and cases will pop up.” No. If there are broadcasts for Thanksgiving, those are recorded as incidents of that following 14 days, then about a week later in hospitalizations and in deaths around Christmas time. Even if everyone stops doing what they do today, cases will still increase over the next two weeks because these transmissions have already taken place.
There is no plan for a coordinated national lockdown or anything like that. And that means the Thanksgiving increase will lead to a Christmas increase and a New Year increase. The current wave we’re in may not peak until sometime – maybe – February. There will be a lot of sickness and hospitalization and death. It’s a really bad situation. That is the pessimistic view of what to expect.
That may be a pessimistic view, but do you think it is that too realistic View?
Yes. You know there anytime could They are a series of latches and if they were long enough and strong enough it would push the curve down. After about 14 days of locking in, we see the trend of the downward curve, or at least a plateau. However, it is unlikely that we will have a federal lockdown before January 20th [Inauguration Day].
One could hope that if states are overwhelmed and our hospital systems are completely flooded, they will introduce more lockdowns at the local or state level. In this case the curves will slope down. Whatever happens to the history of the case, it’s really about what politicians are doing.
In the spring, we heard great concern that the number of Covid patients being hospitalized would overwhelm hospitals. We avoided that for the most part. Are we looking at the realistic possibility that this will start in the next few weeks?
Certainly. We hear from a number of areas in the country where hospitals are already overwhelmed and where all Covid or ICU beds are full.
In the spring, a few things made it possible for us not to get to that point. One of these was the lockdowns that helped smooth out the curve. Another reason is that the outbreaks were relatively localized, so healthcare workers in New York could be complemented by healthcare workers from the Midwest, Florida, or California who could come to New York and take a break.
So you are saying that because it is so prevalent now, Covid is not localized. And that means there is no surplus of doctors and nurses that we can send in from another state, does it?
I agree. If the outbreak is all over the country, there is nowhere for help. There is nowhere to back up.
Places where sick people can be accommodated? That’s something we might be able to find: In the spring, New York was able to build field hospitals and bring in boats from naval hospitals. But people who are trained care for the seriously ill? It’s a really limited resource and these people are exhausted. They have been doing this since January, February and March. Many of them got sick and died themselves. Many survivors grieve when they see so many people die, including their friends and co-workers.
That is really the biggest concern: We are using up our capacities in terms of personnel and their resources, energy and resilience. There is no one to come in and help – unless the federal government would say nurses and doctors are licensed in Canada or Spain or wherever they can add to our workforce. But the government would have to make that decision – healthcare workers who are not licensed in the US may not necessarily be able to work here.
The public appetite for “flattening the curve” has waned. Why do you think this is?
I think there are several reasons. The public health community viewed locking and flattening the curve as two goals: first, to keep hospitals and health systems from becoming overwhelmed in the spring; and second, to give us time to implement and drive more concerted, coordinated public health actions – widespread testing, contact tracing, isolation and quarantine of people who are either exposed or known to be infected.
But in general a lot of these things didn’t happen – definitely not in a coordinated way at the national level. And because a coordinated federal public health response was not put in place during the lockdowns, they didn’t see for many people that they were going to flatten the curve. People gave up a lot. Many have lost their jobs. They couldn’t interact with their friends and family and it was getting nice and summery outside and everyone wanted to get out again. And if we had done what we should have done, they could have done it. But we Not actually do that. So that was a problem: people got sick of being banned.
I believe December 31st was the first time I saw anything about this “unexplained pneumonia.” It was like, “OK, that’s something to look out for. At any moment the established processes will kick in and it will be done. ”
Days passed. Then weeks, then months, and it was like there was … nothing. There is a process that should have been activated. And it wasn’t. There was no answer. We heard that even the mask supplies had no masks or had expired. Things that should have been relatively easy weren’t. The is so different from what I expected.
We kept coronavirus cases low in the spring, however [lacking a coordinated national response,] We kicked the can down the street in the summer. Then we had a summer summit and one little A little try to control that, but mostly just kicked the can down the street in the fall. And now all of our bills are due.
I am curious and cannot answer if this is too personal: is it depressing to be an epidemiologist at this moment?
[[[[Break]]It really is … yeah, it’s depressing. It is frustrating. People keep asking me, “What’s changed? What’s new? What’s this?” New Solution? “The current solutions are the same as in January, February and March. We just have to implement them.
Yes, we are developing vaccines, and these vaccines use a slightly different technique than they did in the past. This allowed us to develop them faster. And yes, we learn which treatments work and which don’t, and we get a better idea of how Covid itself is transmitted. However, you don’t have to understand all of these things to successfully respond to an infectious disease outbreak.
New Zealand did a fantastic job. Vietnam did a fantastic job. Mongolia had no local transmission and no deaths for realizing the severity of the problem very early on and for introducing the things that have worked in public health outbreak response for the past 400 years.
There’s this village in Britain called Eyam. During the Black Plague, it was the northernmost point of the country that the plague reached because when it got there, the people as a city made the decision to cut off contact with the outside world and completely cut off. There was a stone with a depression on the edge of the city, and they poured vinegar into it and left money in the vinegar [which they intended to use as a disinfectant]. People from the nearby town brought them supplies and left them on the stone and took the money. And a large number of people in Eyam died of the black plague, but it did not spread beyond their borders.
This was before we even had an understanding of the germ theory of disease! They didn’t know what was causing the plague. They certainly didn’t know that fleas were responsible for the transmission – it was a mystery. But the city is still there. It’s alive and there are people whose families have lived there for hundreds of years.
We now have better medical treatments. We understand what a virus is and how viruses work. However, our general public health response tools are basically the same: if you are infected, you will not come into contact with people who are not infected. It’s frustrating that it’s still so difficult to implement.
This example really shows an understanding of the causal relationships. You work a lot on this subject. With coronavirus, most things aren’t 100 percent dangerous or 100 percent safe in terms of causal links. How should we think through these decisions and weigh the risks?
Often times, really loud messages try to make things black and white – “always wear a mask” or “never wear a mask” rather than “wear a mask when you’re within 6 feet of someone or.” when you will be in a common interior ”- but there are really two aspects that you have to think about.
First, there is a risk of getting infected and spreading that infection to another person. I still don’t think there’s a common knowledge that you can transmit an infection even if you are completely fine. A lot of people think, “If I feel sick, I’ll just stay home.” But you can feel perfectly healthy, infect Grandma or your neighbor, and find out a few days later that you were sick. We need people who make it easier to think about it.
Second, what activities are risky and how risky are they? This is where the idea of a continuum comes into play. There’s a rhyme there [epidemiologist] Bill Miller of Ohio State University came up with the four dimensions to think about: “Time, Space, People, Place.”
Time: How much time do you spend doing this activity? The more time you spend, the greater the chance of transmission. The less time you spend, the less chance there is.
Space: How much personal space do you have? Can you distance yourself from people? Is it 6 feet or not? When you are singing or cheering, you need more space as your breath particles can move beyond 6 feet. The more personal space the better. If you are alone in the forest and no one is around, you do not need this mask as no one can be transmitted to or infected by it.
People: How many people are there? Do you see these people regularly? Are they part of your core bubble or are they strangers? It is safer to spend time with mostly the same group and safer to have fewer people in that group.
Location: Where is that? Certain places are more conducive to transmission. A small room where everyone is packed together is riskier than a large room. A museum is usually a much larger space than a bar, which is generally smaller and has a low ceiling. It’s safer outside than inside. Inside with open windows is safer than inside with closed windows.
Think through all of this. What are the activities i do Got to do? What are the activities that I am doing now want do? How risky are you? How can I make it a little bit more secure?
Is there anything that surprised you about the way people made decisions during this pandemic?
Yes and no. It’s not necessarily that path People made decisions; It’s like I didn’t really understand how little Everyone outside of epidemiology really understands public health.
Epidemiology and public health are not widespread. They are not taught in high school or elementary school. Until recently, they weren’t even taught in undergraduate college. We see messages about someone who has been quarantined and it turns out 100 people were at their house for a party and they say, “But I didn’t leave the house.” Well, that’s not what “quarantine” means. Quarantine means that you don’t leave the house and nobody comes into the house and you have no contact with anyone.
It never occurred to me that people haven’t yet deeply understood the concept of quarantine. And “quarantine” is almost always used in the media when it should actually be “isolation”. In public health, “isolation” is the term we use when we talk about restricting contact with people who are known to be infected. But if you interview them, people think “quarantine” is for sick people and “isolation” is for people who are not sick – it’s the opposite.
This is an example of something we have to deal with in epidemiology. We have really specific terminology that means really specific things – and it’s often not intuitive, almost the opposite of what non-epidemiologists might think. Unless you’re an epidemiologist, you won’t hear our epidemiologist-specific meaning. But how can we expect the general public to understand our messages when we are basically speaking in a secret code where words they believe have one meaning actually have another meaning, when we use them?
Often I see something and think, “What are people doing?” Your choices surprise me until I step back and think about what we did wrong in communicating.
We have had a lot of positive news about coronavirus vaccines in the past few weeks. Are you concerned that the prospect of vaccines in the months ahead will push people to follow Covid guidelines?
This is always a public health issue and is actually quite hotly debated. It falls under this idea of ”risk compensation” – that people have some level of risk that they are comfortable with, and the question is whether you create circumstances in which they realize that something they are doing is now safer or? to take More Risks?
To a lot of people, this sounds like something that is theoretically likely to happen. But when we actually look at data, it doesn’t seem like people are actually doing that – at least not in a clear, measurable way. At the population level, this is still an open question. You might think, for example, that we all stayed in our homes when the lockdown came, but when it was said that masks can make us safer, people put on masks and walked outside their homes and barbed boxes.
It feels as if it should be a thing. But the bottom line is we really don’t know.
Last question, what should we keep in mind at Thanksgiving this week when we meet in person or via video conference with family when discussing the pandemic?
I hope that people think and talk – especially to their families – and are really open about what precautions they are taking and not, and that they are happy to share this information and accept what the other person will do in response.
I hear a lot of people say things like, “I stayed home for two weeks, then went to my grandma’s and my uncle showed up. And it turns out he visits her every day after going to the bar. I thought I was safe in this room. “Or people who say,” I showed up at a meeting that I thought was going to be small, but when I got there it was a much larger crowd and no one else was wearing a mask. ”
People get an idea of what they are comfortable with and that helps. But we must now make it comfortable to talk to each other about: What are you to do? Is that something I feel comfortable with If not, you have to let me say, “Sorry, let’s just chat on the phone or on FaceTime.”
We need people who are open, open and honest about which risks they take and which they do not and which risks they do not take with one another. This is the next step, especially during the holidays when what people do to meet up can be emotionally charged.