Dean of the School of Public Health Ashish Jha spoke with The Herald Nov. 6 to reflect on how colder temperatures are increasing the prevalence of indoor activities and impacting COVID-19 cases, the rise in cases at the University, Governor Gina Raimondo’s new increased public health restrictions and the implications of the 2020 presidential election on the future of public health in the United States.
Herald: It’s getting colder and people are staying indoors more. We’re curious how you think that will impact podding at the University. Do you think people will develop more contacts and go to indoor restaurants more? How does that affect COVID cases?
Jha: I do think with colder weather coming it's obviously harder to spend time outdoors, especially in sitting-in dining. A lot of the restaurants that had outdoor places are starting to fold them up, bring people inside. That, given where Rhode Island is right now in terms of the number of cases — where the whole country is not just Rhode Island — I think that’s pretty risky. So what I would encourage restaurants to do is to try to push on for a few more weeks of outdoor dining. We have many nice days. You could put heaters outside. But it’s all my way of saying that we want to try to minimize indoor dining as much as possible, and I think that’s going to be important. I think I said this last week — there are a couple restaurants that have made a lot of changes to try to make indoor dining safe — I think that’s great, but most I think have not done enough, so I remain worried that that is going to be a source of more spread.
In general, I think people are just going to be spending more time indoors in the upcoming weeks and months. It’s one of the reasons we’re all very worried about where this pandemic is going over the next six to 12 weeks.
Last week we spoke about University cases rising. This week, again, cases continue to rise — in one day there were seven positive cases — and we mentioned that correlated with the rise in cases in Rhode Island. Could you talk about the increase in cases?
If I look at results by week, if we go back five weeks ago we had two cases during the week, then we had two cases, then we had nine then we had 10, and this week is not over, and we have 12 already. So the trend is very clear but the good news is it’s still very, very low numbers.
There are three points I would make. One is it’s not surprising — it’s exactly what we expected because we don’t live in a bubble and as much as we can try to have people spend time in pods and as much as we can try to protect people who are on campus, the truth is we live in a community, and when infection rates rise in the community, we’re going to see more cases here.
The second thing is the trend is the thing to pay attention to, and the trend is going up. We have to look at where those cases are coming from. A lot of them are in faculty and staff, which also makes sense because faculty and staff are much less likely to live on campus — they’re much more integrated into the community. Try to think about where those cases are happening and do good contact tracing.
Third is we have to watch this carefully. We have about three weeks before Thanksgiving, and at this point I think if we can keep things steady, I think we can make it all the way to Thanksgiving without large outbreaks. The thing about this virus is it can shift very suddenly, so you could be cooking along eight, 10 cases and then boom — you get a spike. And it really takes one event, one gathering where a bunch of students get together on some Friday evening and people break their pod and get together, and one of those could just shut the whole campus down. So we have to, I think, remain very vigilant really just for the next three weeks; it’s not forever. If we can get through Thanksgiving then we can decide what’s going to happen afterward, but I think that’s always been the critical goal for this semester.
Governor Raimondo announced the new public health restrictions that she’s putting into place starting on Sunday, which include social gathering limits but also the stay-at-home advisory — could you talk about what impact you believe those restrictions will have, and what you think about them at this time?
Governor Raimondo certainly did those — Governor Baker in Massachusetts did something similar a couple days before. There’s actually quite a diverse set of views on how useful these are going to be.
I think lowering the indoor gathering is absolutely a good idea, and I don’t think anyone questions the importance of that. Where there is more disagreement is around curfews and what people argue is that that is not enough because the virus spreads at 7 p.m. as much as it spreads at 11 p.m., so saying to people you can’t be out at 11 p.m. doesn’t necessarily help.
I actually disagree with that a little bit. I think curfews can be important — they’re probably not enough — because while the virus transmits just as efficiently, people’s behavior changes by 11 p.m. If you are out at a bar at 11 versus a restaurant at 7, you’re largely going to behave a little differently.
So part of it is about cutting off the kinds of behavior that really leads to a lot of spread. So I think for that reason, the curfews make sense. The big question is: Is it enough? And given how much transmission is happening in Rhode Island, my general feeling has been we should be more aggressive, not less aggressive. And I know that the governor is trying to walk a fine line on this. So we’ll have to see over a week or two how this plays out.
Looking at what other states are doing, are there any recommendations or examples of additional restrictions that could be beneficial? And, how much do you think the people of Rhode Island will adhere to these kinds of regulations looking at the example of other states?
A lot of it will depend on local leadership — not just the governor but also mayors and other individuals. If they can keep reinforcing the messaging, I think it will help. One of the things that some states have been doing — California and New York — that I think is pretty interesting is microtargeting. So instead of saying statewide we have a policy, in New York there were certain zip codes or neighborhoods where the numbers were really rising a lot, so they said we’re going to shut down all restaurants, retail shops in those neighborhoods … where the outbreak is the worst.
I like that microtargeting idea. I think that’s generally pretty smart because it allows you to focus on where the cases are without having to do it for everybody. It obviously takes a lot of active surveillance and focus, and that's what I think Rhode Island is trying to move more towards.
What we want to do is avoid the kind of broad shelter in place: everyone stay home 24/7. That’s what we want to get away from. You only should have to do that when things are completely out of control, and it’s everywhere and you have no mechanism to slow it down. We’re not there yet, thankfully, and I think the best way to avoid getting there is really these micro-targeted policies that really go after where the outbreaks are happening.
In terms of how long these types of policies should be put into place, do you have any thoughts on that — what length of time is effective?
The key thing to remember is any policy that goes into effect this Sunday, we won’t see its effects for at least a couple of weeks just based on the epidemiology of the virus. We can’t a week later look and say it’s not working — we have no idea if it’s working a week later or not. We really have to wait a good two weeks before we can see its effects.
And then in my mind, if it’s working, you want to stay with it until you really bend that curve and start getting the number of cases going down. If two weeks later you really have not made much progress then you got to ratch it up. That to me is the timeline for assessment, but how long you keep it in place is really going to be driven by what the numbers are and how quickly it brings cases down.
What could the outcome of the election mean for public health?
So let’s break it down into three buckets: election itself, transition period and what happens after Jan. 20.
First, the elections. What I was really worried about was large-scale disruptions in voting (and) counting. We’ve obviously seen some but not a lot. Overall things are going reasonably smoothly. What I still remain worried about is … if we get ... civil unrest — of course there is all sorts of other issues — I’m going to worry (about) what the impacts will be on the pandemic.
Because it’s not just that people are going to be outside, but they might get into buses and go to Washington. So for a variety of reasons, not the least of which is I just want a functioning democracy, I’ve been hoping that we can just get through the election period without much unrest.
Let’s assume that we do and that things kind of go okay — then there is a transition period. The transition period is about two and a half months, and these are going to be the hardest two and a half months of the whole pandemic. So I’ll tell you what should happen and then a little bit about what I’m worried about.
What should happen is we should use the model we used in 2008. In 2008, President Bush was leaving, President Obama was coming in, and we were in the middle of the worst financial crisis in 70 years. And what happened was there was basically a joint team made up of people from both the Bush White House and people on the transition team for President Obama who worked together during that transition period to make sure that there was a functioning federal government that was doing its job in terms of dealing with the financial crisis. Well, we had the worst public health crisis in a century and the next two months are going to be really hard. What would be ideal would be a joint task force made up of people like Dr. Fauci and Dr. Birx and some other senior people in the Trump administration who are pretty science driven — or have been trying to be — and people on the Biden transition, and they work together so that you can have a functioning government during these two and a half months.
That’s what we need and that's what we should demand. I’m a little skeptical of whether the Trump White House is going to be interested in doing that. If we really don’t have any federal leadership over the next two and a half months, it’s going to be a huge problem, and what then needs to happen — plan B if plan A fails — is that Congress needs to pass a stimulus bill that gets the money to states, and then states have to do a lot more. But 50 different states all doing their pandemic response is not where we want to be.
I do think that after Jan. 20, we are going to see — because I’ve talked to the Biden team — a national plan on testing; we are going to see a lot of work on rolling out of a vaccine. I do think we’re going to see real efforts on mask wearing, so there’s a lot of stuff that’s coming, but the truth is that none of it will get implemented by a Biden team until after Jan. 20 unless we can create that kind of transition taskforce.
Any final thoughts or messages to the Brown community?
It’s been an extraordinary fall. People have done a very good job of being thoughtful and careful about their behavior and we have a couple of weeks to go so people have to hang tight.
If people continue doing what they’ve been doing for about two to three more weeks, we get to Thanksgiving, I think it will make an enormous difference in terms of keeping people safe and getting people home safely.
So, if people can keep doing what they’re doing — wear your mask and stay in your pods — it will make a huge difference and help our community.
This interview has been edited for length and clarity.
—Additional reporting by Emilija Sagaityte
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