Coronavirus Report

Coronavirus Report: The Hill’s Steve Clemons interviews Jennifer Nuzzo

The Hill’s Steve Clemons interviews Jennifer Nuzzo, with the Johns Hopkins Center for Health Security.

Read excerpts from the interview below.

Clemons: How did we get here given the fact that people like you were forewarning of such dark days?

{mosads}Nuzzo: Yeah, it’s been really an unfortunate road that we’ve been on. I mean, I think anyone who has studied pandemics and these sort of viruses, you know, once we knew in January that this virus was capable of sustained human-to-human spread that meant that we were on the path to a pandemic. And so, you know, many of us — lots of us — talked about the need to urgently prepare. Unfortunately, there wasn’t a lot of action that happened in January and February, and I think where we found ourselves mid-March, where we were looking down at rapidly accelerating case numbers and worried that we were headed for health system collapse like we were seeing in other countries, you know, that really kind of put us into a position where there was no choice but to implement these very broad and, frankly, you know, damaging in their own right, but nonetheless necessary, lock down and all sorts of other restrictions in an attempt to kind of hit pause and make up for lost preparations. 


Clemons: If you were called back to Congress to testify at some point for some commission that looked back on this, what do you think the points of dysfunction were that mattered most in getting us to where we are today? 

Nuzzo: There are a few things. I mean one, obviously, the inability to more broadly test for the virus that causes COVID-19. I mean, we constrained for a very, very long time far too long who could get tested for it. So, for months, even after this virus was circulating in many countries across the planet, you could only be tested if you had traveled from Wuhan. We had also shut down travel from Wuhan. So, essentially that left no one to test. Nonetheless, we didn’t expand testing at that point. And so, what that meant was that the virus could enter the country. It was already there. It was circulating, but we couldn’t see it and that really made us lose ground. One, because we want to find where the infections are so that we can isolate those people, prevent them from spreading their infection to others, prevent the case numbers from growing and taking a real foothold. Other countries that acted early were able to keep their case numbers low, but we never did that. But beyond just the testing, the laboratory issues that we had. And it wasn’t all the same, I mean, there were laboratory issues, we couldn’t get the test kits out to the state public health labs, and that was a problem. But aside from that, there were other places that could have done testing. We should have fixed that. We basically put all of our eggs in one basket, which was to ban travel, which, you know, may sound like a good idea. It seems, you know, it probably sounds reasonable that if the virus is somewhere else, you don’t want it to come here, and so that the way to do that is to stop people from traveling from those places. The problem was, we actually didn’t know where the virus was because many countries weren’t yet testing and we only banned travel from a few places because logistically it would be impossible to support the travel bans had we expanded it, and so that put all of our eggs in one basket. In my view, I think it’s psychologically reinforced this idea that the virus was a problem across the globe and not necessarily a problem that was already likely circulating in the U.S. I think that’s one of the reasons why we lost time preparing, thinking about how we were gonna isolate sick people, thinking about how we were gonna expand capacities and hospitals, thinking about how we were gonna protect nursing homes and other vulnerable groups. So, it’s really unfortunate. But I hope that now that we’ve had this pause button that the restrictions have enabled that we’ve been using this time to try to make up for lost ground. 


Clemons: Surgeon General Jerome Adams continues to highlight that communities of color, communities in lower socioeconomic areas are vulnerable communities and they have not had the level of decades on health, investment and ecosystem investment that other communities have. So, they have an underlying condition generically, but they have lots of health underlying conditions. Do you agree with the surgeon general? And what do you think we need to do as a nation to address the disproportionate way that coronavirus is hitting those communities?

Nuzzo: Yeah, it’s very clear from both the case numbers and the hospitalization data, and the death date unfortunately, that communities of color are being overrepresented and really harder hit than many of us, which is really just a very, very unfortunate situation. I think there are a number of factors that contribute to this. I mean, clearly, underlying health conditions are an issue. We also know that those underlying health conditions don’t occur in a vacuum. They are also associated with socioeconomic status and income. And you know the ability to obtain healthy foods can be associated, or the lack of ability, with certain chronic conditions. So, there are deeply entrenched disparities that contribute to this. But also, you know, I mean, the main way that we have been protecting ourselves in these months is telling people stay home as much as possible, telework if you can, and that is not something that’s available to all people. Not everybody has the luxury of being able to stay home. Many people are service workers and have to go out because they’re essential. But also they need a paycheck to support their families. And so, being able to stay home, frankly, is a luxury and it’s not one that’s available to everybody. So, there are lots of different ways. We’re also hearing about disparities and accessing care, particularly accessing testing for COVID-19. There’s been some great reporting lately, suggesting that testing sites tend not to occur in some of the harder hit areas because, you know, if we rely on [national retail] chains, they may not have stores in certain neighborhoods, and so access issues are huge. If people aren’t able to be tested early, they’re not able to seek care, you know, when they need it, that obviously can worsen their outcomes and unfortunately with deadly consequences. So, all of the injustices and inequities that exist in our society, I think are playing out in the case numbers. 


Clemons: You are a scientist. How’s the morale of the average person in the world of science today given some of the disregard for science that we’ve seen in some quarters in Washington?

Nuzzo: Yeah, I mean, I think first of all anyone who has any knowledge about COVID-19, and that’s a large part of my academic community, I think a lot of us have something to contribute. We’re all pretty exhausted, mostly because we feel an urgency to contribute and in our world it’s contributing what we know and there’s just a lot of need for information right now. So, most people have been basically working around the clock trying to make the situation better the best we can. Obviously, there is a deep disappointment that we got to this point, particularly for those who have been involved in the preparedness community and sounding the alarm for decades. There’s a deep disappointment that we turned out to be right on many issues. We sort of hope that these things never happen, but we very much know that they can. But, you know, at the end of the day, those of us in the science community and particularly those who are busy and right now are luckier than most, many of us are not on the front lines we are not the ones putting our lives and families at risk and we are employed and, you know, still getting a paycheck. So, I personally consider myself lucky. You know, my kids are at home. I’ve got two young kids that we are trying to home-school at home. It’s really, really difficult and my kids are suffering. But as a family I would say we’re luckier than most. We breathe every day and we’re safe. 


Clemons: Larry Kramer, a gay, anti-HIV/AIDS activist used to pester Anthony Fauci to come up with a solution to AIDS faster and to talk about this as being a plague. So, Larry Kramer was an icon to many people and said he bent the curve in terms of what was possible in terms of vaccines dealing with people and de-stigmatizing at that moment. I don’t know whether we have stigma issues out there. But, I see some people not reporting that they’ve had COVID-19 until much later in fear of the consequences of that. But is stigma an issue? Are we having problems with getting the resources in the right place for vaccines? Do we need a Larry Kramer today? 

Nuzzo: Well, first of all, I think we always need a Larry Kramer. I mean, the more that people feel an ownership of this issue and realize that when we’re talking about public health, we’re talking about them. The more the public is in public health, the better. And I think a really engaged and energized populace is the pathway to public health protection. I think a number of countries that have done really well in responding to this, one of the things that I’ve noticed is that they have data that’s highly available and completely transparent so that people can see what’s going on and know what’s going on and make decisions for their families and hold the authorities to the appropriate standards. So, I think an energized and engaged populace who feels that this is important to them and take interest in it is always important. On the topic of stigma, this is a hallmark of infectious disease outbreaks. This almost always happens. I am not a social scientist, but I have a good colleague Dr. Monica Schoch-Spana who’s a cultural anthropologist who studies this very topic on stigma. What she has taught me in her decades of looking at this is that often when we have these scary and seemingly unexplainable events happen to us as communities, we look for someone to blame, and unfortunately we cannot always find someone to point a finger at. And so that is one of the things that contributes to stigma. There’s always a perceived cause of the disease, even though the cause is really the virus and not a person. But that stigma is out there, and it has enormous consequences, including, and we’ve already heard this, there’s been some reporting now about people not wanting to be tested that have symptoms of COVID-19 because they don’t want to be identified as such. They, you know, may not seek care if they are experiencing worsening of symptoms because, you know, they’re sort of afraid of being known. And this can have enormous consequences. One of the things I’m deeply worried about is some reporting that happened over the weekend out of Minnesota, where law enforcement in commenting on the protests, talked about conducting contact tracing on the people who had been arrested, which is an extraordinarily unfortunate phrase to use because contact tracing is a real public health tool that we will need to depend on in order to control COVID-19. What it means in a public health context is when we find a case, we try to figure out who that case may have exposed in the time in which he or she was contagious but possibly didn’t know that he or she was infected. And then we go and try to find those people and tell them that they were likely exposed to COVID-19 and that it’s in everyone’s best interest that they stay at home until we know for sure that they’re not sick. When public health does this, it is not a law enforcement action. It is something that we do to help people. Nonetheless, when law enforcement appropriates that term for their very different activities, I worry that it can have deep consequences and it will drive cases underground. And I fear that it will make people fearful not only of being diagnosed, but also potentially participating in real public health, beneficial contact tracing activities.  


Clemons: What do you think we need that we don’t have in place today?

Nuzzo: We’re hearing a lot of reports of people being hit with very large treatment bills. So, when you know all of the kind of action on the Hill happened, one of the first things they did was to make sure that people could be tested for COVID-19 for free, or at least not have a fear of costs prevent them from being tested. I think that those actions largely, but probably not completely, solved the problem. But what was not included in that was assurances that people’s cost of treatment would be covered. And, some colleagues and I wrote an op-ed a few months ago, basically calling for a public health crisis insurance that would not only ensure that everybody had full coverage, but also that could capture data on who was being treated and what their risk factors were and what their outcomes are because we’re still trying to learn about this virus and doing so with very imperfect data systems. One of the things that we’ve been doing at Johns Hopkins is tracking COVID-19 and most recently stood up an effort called the Testing Insights Initiative, trying to understand who’s getting tested and who’s not, and how testing compares between states because there’s no other way to interpret the case numbers. We need better data. And the extent to which we are systematically omitting people from our data capture systems because testing is not available in their neighborhood or people are sort of off the grid, if you will, persons experiencing homelessness, it’s a big problem. But nonetheless, we’re not going to be safe unless everybody is taken care of. We saw this in other outbreaks. Just before COVID-19, there were enormous outbreaks of Hepatitis A occurring across the U.S. in large part in persons experiencing homelessness. One of the issues is that they very much rely on private businesses as places to wash up and use the restroom and all those places are closed in many communities. So, I can imagine there’s going to be huge tolls unless health authorities and social service organizations are able to have a COVID response plan in the communities of persons experiencing homelessness 

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