In the inaugural episode of “The COVID Pod with Dr. Ashish Jha,” The Brown Daily Herald’s Editor-in-Chief Colleen Cronin ’21 joins Dean of the School of Public Health Ashish Jha on Zoom to discuss the national news surrounding ongoing vaccine trials, President Donald Trump’s COVID-19 diagnosis and treatment and the risk of group gatherings. Jha provides expert insight into the state of affairs in Rhode Island, at Brown and across the country. This episode was recorded on Friday, Oct. 16.
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Read the Transcript:
Colleen Cronin
Hi, my name is Colleen Cronin and I am the editor-in-chief of The Brown Daily Herald, Brown’s independent student newspaper. Today I am with Cate Ryan ('21), our senior science and research editor because we have started a new public health podcast.
Cate Ryan
Yay, yeah, we’re really excited to be bringing you into our conversations with Dr. Ashish Jha who is the dean of the School of Public Health here at Brown University and was formerly the director of Harvard’s Global Health Institute. Over the course of the pandemic, he has become a well-respected and well-known voice on public health measures and everything basically relating to this virus and how we can best handle this situation.
Colleen Cronin
You might’ve seen him on CNN, you might follow him on Twitter.
Cate Ryan
We’re really excited to have this opportunity to speak to Dr. Jha so everyone can be fully up to date on what is happening here in Rhode Island and around the country.
Colleen Cronin
Stay tuned. If you have any questions that you’re interested in hearing about from Dr. Jha, please feel free to email herald@browndailyherald.com.
Cate Ryan
Yes, here’s the episode.
Colleen Cronin
Thank you so much, Dr. Jha, for being here today with us. We're super excited … This will be the first time we are doing a podcast with the BDH. And we're so excited to be doing it with you.
Ashish Jha
Oh, good. Happy to help make it the inaugural event. It's going to be great.
Colleen Cronin
So we just sort of wanted to start off and ask, you know, how you are the new dean of public health at the School of Public Health. So how are you doing at Brown? How has it been so far?
Ashish Jha
Yeah. So first and foremost, I think it's strange to start a new job in the middle of a pandemic, right, like, just an office. I mean, any new thing has a certain set of rituals, you go meet people, and you get to know a community. And I'm actually doing that, but it's much, much harder, it's much more vertical. But I have to tell you six weeks in, I am really having fun. Like this is a fabulous place. And it's very easy to compare, but it's very close knit in a way that I wasn't expecting across the entire university. You know, I grew up in an academic environment where every school really was kind of on their own. And there was very little crosstalk across schools. And that's very different here. And so I really feel like I'm part of a broad university community, and I'm really enjoying it as much as one could be enjoying anything in the middle of a crazy pandemic. But yeah, so far, so good. Six weeks in, I'm having a good time and hopefully, helping the school think about, sort of, new opportunities and tackle some challenges.
Colleen Cronin
Have you tried calamari yet? Rhode Island's famous calamari?
Ashish Jha
Oh my god, I’ve tried at least … somewhere between half a dozen and a dozen different places at some point. And not that we'd want to ever make a podcast all about the different calamari places, but maybe I need to write up, like, my personal experience with Rhode Island calamari and what I like the most, but we probably would create a bit of tension across restaurants … We’d have to be careful.
Colleen Cronin
Oh, we can maybe have you write a guest column for The Brown Daily Herald?
Ashish Jha
That would be awesome. “My Adventures with Rhode Island Calamari.”
Colleen Cronin
Oh, and then also you'll have to tell us about coffee milk and your opinions on that. So I'm just sort of asking you what have you been up to this week in terms of public health stuff? I'm sure you have been following everything that's going on. I saw news this morning about Pfizer potentially getting an emergency approval for mid-November. I don't know if you've seen that breaking news. And then of course, Johnson and Johnson, there is an issue with mysterious illness coming out of their trial. So I'm wondering, you know, what are you thinking about that this week?
Ashish Jha
Yeah. So this week, what's been one of the major things … So one major thing that has come up this week is this Great Barrington declaration. I don't know if you've heard about this. In some ways it's not worth advertising. But it's basically a small group, these three academics from, you know, very great institutions — one from Harvard, one from (the University of Oxford), one from Stanford (University) — wrote a piece basically arguing that we should try for herd immunity, that that's the right approach, for our country and for the world. And they did it in Great Barrington, Massachusetts, which is why it's called the Great Barrington declaration. Not because it's a great declaration, it's actually quite a problem. But the White House (has) essentially, in some ways, endorsed it. Scott Atlas, who's the main adviser now to the president has been talking it up. And if you read it, it reads like, sort of, mom and apple pie, like you read it and you're like, “Yeah, that sounds great.”
But it's hugely problematic, because if you actually think about how you'd go about implementing it, it will cost millions of lives in the U.S. and around the world, and largely wouldn't even work. And so it's been very interesting, because you have this small group of people saying, “Oh, there's disagreement among public health experts.” But there really isn't. And this has occupied a lot of time this week sort of trying to counter this, really, I think, very destructive and kind of unworkable idea of trying to achieve herd immunity.
And, you know, sort of pretty par for the course for this pandemic, which is, instead of spending time trying to figure out how to deal with complicated problems, the whole pandemic has been marred with these little, like, “Hydroxychloroquine is our solution.” And then you have to spend all of this time saying, like, “No, hydroxychloroquine actually doesn't work for COVID-19.” And then it's like, “Oh, it's convalescent plasma.” And you're like, “Well, actually, the data on convalescent... So it's just, it's these things that come out that you end up spending so much time on, as opposed to just dealing with the virus. And that has been a very consistent theme. And it's been really frustrating.
Colleen Cronin
Sort of thinking about some of the news that we're getting about a vaccine, do you think... I think you probably do think this, and you've talked about it a little bit before in other places, but with people coming out with these ideas about, “We'll just do herd immunity.” Are you concerned also that, you know, when a vaccine does eventually come out with news like, “Oh, a mysterious illness has popped out of one of these trials,” that people are not going to be receptive to the vaccines?
Ashish Jha
Yeah, so the issue of vaccine hesitancy is really important. And you know, about a week or a week and a half ago, I had one of these dean conversation series I've been having. It was with Heidi Larson, and Heidi is a professor at the London School of Hygiene and Tropical Medicine. But she really is, like, the world's leading expert on vaccine hesitancy and what drives people to be hesitant around vaccines. And ultimately, what I have learned from her is that when it comes to things like vaccines, it's not just vaccines. You have to understand what is really driving people's uncertainty and their lack of confidence, and you have to address it, and you have to address it with compassion, and not by beating them up and calling them anti-science anti-vaxxers. And saying that they're somehow not as smart. And I feel like there is a lot of vaccine hesitancy in America right now. And I'm very sympathetic to what is driving it.
That's not my way of saying people should be hesitant. I actually think the vaccine development process has been done with incredible integrity, like it's been done really well. And when you see that pause, Colleen, for the mysterious illness — I look at that as good news, and I'll explain why. We have been racing towards a vaccine, we have been moving so incredibly fast. And the worry that all of us have is that the standard guardrails we have built for making sure that things are safe and effective, that somehow those guardrails will get violated in the desire to get a vaccine out. We won't pay attention to all of the little signals that pop up along the way — that's a worry that I've had in the back of my head. And every time I see a pause, I think, “Ah, good.” Like the guardrails are working. That's what it's supposed to do. You never get a development of a vaccine or a drug without some pause along the way, because, you know, something happens to somebody and then you have to say, “Is this vaccine related? Or did somebody just have a random illness?” And then you pause, you take time to sort it out.
Most of the time, it's not vaccine related. Sometimes it is, and you make a determination, but you let science kind of drive all of that. And every time I see a pause, believe it or not, it actually, for me, makes me that much more confident that we're doing this right. It also means that maybe some of the vaccines won't get through, maybe some of the vaccines won't be safe. But that will mean that the ones that do get through will have gone through a really rigorous process, and we'll be safe. So I know that people look at these pauses and get concerned about what's going on and “Are we gonna have a vaccine?” I look at them and say, “Great, process working.” You want these things, you want to see these pauses. If there were never any pauses, I’d actually be really worried that we weren't doing this right.
Colleen Cronin
Well, that makes me feel a lot better.
Ashish Jha
Science is working.
Colleen Cronin
Isn't that... We love to hear it. You know, we talk a lot about vaccines. But we also talked about therapeutics. President Trump has been sort of, we've been following the wake of his diagnosis. He seems to be doing pretty well. But he definitely is in demographic groups that we would be concerned about. And so I'm wondering if there's anything about either the fact that he was getting tested so frequently or, you know, any of the treatments that you've heard that he was receiving, if they're promising for some of the age groups or the demographic groups that he's a part of?
Ashish Jha
Yeah, so he is in a high risk group. He's obviously older, he's 74. And he's overweight. And we don't know if he has high blood pressure or diabetes. But either way, he would be in a high risk group. And, you know, the therapies he got first was an unusual mix; I don't say unusual to suggest that what he got was inappropriate, but unusual. So there probably isn't anybody else in the world right now (who) has gotten exactly the three things he got. But he's the president; he gets access to certain things. So the Regeneron antibody, the monoclonal antibodies he got — I've actually been very hopeful that they will end up being a really important part of our approach to therapy. And, you know, we have some evidence that it works, but not a ton of evidence yet, but that's okay. And he got it as a kind of, you know, as a one-off, and I actually suspect — I don't know, obviously — and this is a sample size of one … but I suspect that that probably was an important part of what helped him turn around.
He also got Remdesivir, which, in general, the evidence has been that it's modestly helpful, but no slam dunk. There's actually a trial out last night from (the World Health Organization) that actually shows that Remdesivir: maybe not helpful at all. I just haven't had a chance to dig into that data to see why it looks a little different from some other data. But it is confirmation that Remdesivir probably, if it's helpful at all, it's helpful on the margins … And then (Trump) got dexamethasone, which is a steroid, which you tend to use (with) really more severely ill people. And he tried to use it also late during the disease course. And that, to me, was a bit puzzling. But he's got some fantastic physicians at (Johns Hopkins Hospital) and had (Walter Reed National Military Medical Center) managing his disease. And so I just, I'm not going to second guess them; they had access to data about his care that I don't. So we got a bit of an unusual mix. But I think that antibody therapy — that's really the promising one, (Eli Lilly and Company) has there. So as well, I have no reason to think one is better than another. And we'll see where that treatment goes.
Colleen Cronin
And sort of also zooming out a little bit from, you know, when he was diagnosed, are you feeling or seeing anything that indicates that maybe his diagnosis is driving more caution? Do you think that? Hopefully not the opposite is happening?
Ashish Jha
Yeah, you would hope right, that he, getting as sick as he did … I think you would hope that he would turn around and say, basically, “This is a very serious disease, and people have to be careful.” And, at least to me, it's been a disappointment that he has turned around and said things like, “I am immune.” I don't know that he is. He has said that you should not be intimidated or fearful of this virus. Now, fear is never a good thing. So I guess on some level, I agree with that. But he certainly has not urged caution and people taking more care. And instead and certainly through his actions or the rallies he's had, where he's packed people together, wearing, not wearing masks — it has struck me as he has, in fact, doubled down on his old strategy of trying to bluster his way through this pandemic. And it's not working because the virus doesn't get intimidated. It doesn't get blustered and therefore off its game. It's simple biology and math. The virus does what it does. And if you ignore it, it doesn't make the virus go away.
Colleen Cronin
Yeah. I hope that there's some lessons to be learned from what has happened to him. But I guess we'll see. Sort of then, talking more about Rhode Island: Brown college students hopefully — we'll be listening to this podcast and talking about the large crowds, I think something that we saw even in (President Christina Paxson’s P'19) email … about two weeks ago. Now. Obviously, we shouldn't be going to large parties and gatherings as college students, but I think the conversation is also shifting a lot to encouraging people to not decrease the size of their social network, which has always been a conversation, you know: keeping in your pod, limiting the number of people you're interacting with in a non-socially-distant way. But I'm wondering if part of her email had talked about how other outbreaks at other colleges have been: (not because of) large parties, but because kids are hanging out with lots of different people. And I'm wondering if you could speak to that at all, and how much you think that might be contributing to any outbreaks that are clusters that we've been seeing recently?
Ashish Jha
Yeah. So let's talk about what we know about what's happening in the broader community. And then let's shift to thinking about its implications for Brown and colleges, maybe more general and then Brown specifically. So, as you know, the number of cases in America is really starting to tick up in a very concerning way. About, around Sept. 12 or 13, we were averaging about 33-35,000 cases a day. We are now well over 50,000. And the way to think about this virus — and this to me has been at least a kind of mental image that has been really helpful — is that infections in the community are like a freight train in that, when they start picking up, you just see sort of slow movement … And you sort of lull yourself into believing it's not a big deal.
But the biggest thing about freight trains is that they have incredible amounts of momentum, right? And so they're hard to move. But once they get going, they're incredibly hard to stop. And we have spent the last four, six weeks as a country, just letting the momentum build. And we are now at a point where if we don't make some important changes, as a nation, we are going to have a very hard time over the fall and winter … We've seen about a 35-40 percent increase in cases across the nation. And some places like Wisconsin and (the) Dakotas, they're up to 300 percent over where they were two months ago. That is a real problem. And that's what we want to make sure doesn't happen in Rhode Island, because what happens in Rhode Island will of course affect us at Brown.
So we care both because (of) Brown, but also because we're in Rhode Island: We care about Rhode Island. We're starting to see real momentum in the number of cases in Rhode Island, a number of cases going up quite a bit. (The) percent of tests positive has really gone up quite a bit. I am concerned about where Rhode Island is. … But I'm really concerned about where the nation is. So what's driving this, right? That's sort of the question that you asked … So if you look at the studies that have tried to figure out where (people are) getting infected, some of it is in?
Well, actually… Let's take a step back. What do we know about where the virus spreads? The virus spreads when people gather indoors without wearing masks for any extended period of time, right? So now let's apply that kind of lens to: Where do people gather indoors without wearing masks for extended periods of time? Restaurants, because you can't wear a mask consistently. Now, there are some restaurants that are trying very, very hard to make indoor dining safe. And I say I think they can. But a lot of restaurants aren't. Bars are particularly problematic, … because obviously what's involved in bars is alcohol. And as soon as people start drinking, they let their guard down, they start speaking a bit more loudly. And so bars are incredibly efficient spreaders of COVID.
But the other part that we have not paid attention to — and I'm staying out of the college realm for a second, I'll get into it — is home gatherings, and that's actually causing a lot of spread. Because what happens is people have this mental image of, “Oh, it's dangerous out there, but it's safe inside my home.” And so then they invite eight or 10 friends over. And then there's alcohol or food involved because of social gatherings. And what happens is somebody in that group is an asymptomatic spreader and feels fine. And they will spread it to 20 people or 30 people, and those people will go home and then they'll spread it to others. And you start seeing these large outbreaks that come from home gatherings. So that's what's driving it in the community.
And then when you shift to thinking about: Well, what do we do in colleges? I don't believe, for instance, that there's much evidence that getting students together in a class is risky. Why? Firstly, you're wearing a mask. You're at a social distance. Hopefully people are not drinking alcohol in class. And that was a bit of a joke. They're not. They're not. And the bottom line is that … there's not a lot of yelling and screaming, right? At least in most classes. So if you can kind of keep all that to a minimum, having people in class, especially with a little bit of social distancing, is pretty safe because it doesn't meet those kinds of criteria. Obviously, large parties are going to be a problem. But the other part of it is: If you're socializing a lot — so you’re just going out with friends or seeing them in your dorm room or in your apartment a lot, if you're mixing with a lot of folks — and you're not wearing a mask, and especially (if) you have a friend over, a lot of people will then take off (their masks) and you hang out. Essentially, you're creating an environment, (where) one of those people will be an asymptomatic spreader. And they'll spread it to you, and then you'll spread it to others. And that's how these things will get going. So just trying to be more thoughtful about that.
And that's actually a major reason why we're testing everybody, twice a week, because you won't pick up everybody who's got an asymptomatic spread, but you'll pick up a vast majority of them. And so it adds a very big layer of protection, not 100 percent, right: We have seen outbreaks happen, despite testing. But the fact that our testing numbers look as good as they do make me feel pretty confident that people are doing a good job and we've got to keep going. And we've got, you know, we've got another six weeks to two months before … If we can get to early to mid-December without (spikes in cases), then we're good for the semester. And I have lots of hope about what's going to happen starting in January, about what kind of ways we'd be able to keep people safe. We won't have widespread vaccine availability by January, but there are other things we may be able to do to keep people safe. So it's really about... What I'm saying to folks is: I'm asking for a change of behavior for the next six months, really for the next couple of months. And then we'll be able to maybe relax some things as we get into the new year.
Colleen Cronin
Are you concerned at all about seeing sort of a spike? We had a long weekend last weekend. And after Memorial Day, and then after the Fourth of July, you know, all these events where people get together. We've seen spikes in the numbers a couple weeks later. Are you concerned about that at all? Or do you think people maybe have changed their behavior based on these other events that have happened?
Ashish Jha
Yeah, right. So, as you said, and it's completely true. After Memorial Day, we saw a big spike. (And) after July 4 and Labor Day … typically what happens is about 10 days after the weekend, when you look back at the data, you see it start taking up (to) about five, six days after; (it) just takes a little bit of time for it to show up, right? Because imagine this past week, on Monday, if I had a house gathering and 20 people came — which I didn't. But imagine I did. And a bunch of people got infected, they probably wouldn't even have any symptoms until Thursday, Friday. They might get tested on Saturday or Sunday or Monday. And so it takes a little bit of time for it to show up, right? And so we haven't seen any of that data.
But I'm absolutely concerned because it just keeps happening after every holiday weekend. So I don't know that the message about what's happening in your home (is not) automatically safe, has yet gotten through to people. And I think we need to be clear about that. Now also, on holiday weekends, people tend to go out to restaurants more and bars more. I have just yet to come to conclude that there is almost no justification for having bars opened during this pandemic. And some people have done estimates that suggest that it would cost about $30 billion. And that was from July, it's probably even less now to just basically pay bars to survive the next six months and pay their employees so that we don't see every bar shut down. We don't want to see that. But that's a small price to pay nationally to stop large outbreaks from happening.
Colleen Cronin
Oh, I wish that someone was listening to you. Just sort of talking about Brown specifically, in addition to doing a stint in asymptomatic testing at the (Olney-Margolies Athletic Center), (they’re) doing flu shots. Are you starting to see any sort of information about what you know? It's probably not (time) yet, but how (about) any flu-COVID crossover data, or any way that maybe you're worried the flu this year could negatively accelerate the impact of the pandemic?
Ashish Jha
Yeah, I'm actually optimistic that we're gonna have a really mild flu season. And for two reasons. One is that I'm hoping that people will get vaccinated this year because, again, if you don't, if you don't get vaccinated, your chances of getting the flu are gonna be much higher. You're gonna be more likely to end up in a hospital. And this is the year you don't … I mean, you never want to get the flu, but particularly this year, so I'm hoping that vaccination rates will be high. But actually, more importantly, all the social distancing and hand washing, and all the stuff we're doing for COVID will have lots of benefits for the flu. So (we) haven't seen much (of an) uptick of flu activity across the nation yet. I would not be surprised if we start seeing a little bit as we go further into October and into November.
But I'm guessing, hoping that it's going to be pretty mild compared to, like — we might be 80 or 90 percent— lower levels of flu, certainly in areas where people are wearing masks and doing a good job on all the kind of public health stuff. There are parts of the country where people are just acting like it's all over and they're back to normal. You know, there you can have problems both with flu and COVID. And the flu can fill up hospitals on its own, without even COVID. So for places that are not doing a good job on public health measures, it's going to be a very hard fall and winter.
Colleen Cronin
Dr. Jha, thank you so much for talking with us today. We really appreciate it. And we look forward to talking to you again in the future. And hopefully, next time, you'll have some coffee milk recommendations for us.
Ashish Jha
Yeah, that sounds great. I will work on that. And look, thank you so much for having me on. This was a lot of fun. It was a great conversation. And I know it can feel a little bit of a downer where we are. But I actually think the good news here is we know what to do to get through the next few months. It's not like, “Oh my god, it's a mystery. How are we going to get through it?” We can do it. And if people stay focused, there's a lot of good news coming in 2021: We're going to have multiple vaccines that are safe and effective. We're gonna have widespread testing availability. There's a lot that's coming. So what I say to folks is: Hang on, let's get through this and 2021 will be much better. And I look forward to more conversations between now and then to help people get through this difficult time. So thanks so much for having me on.
Colleen Cronin
Thank you. Thank you.
Ashish Jha
Stay well, everybody.
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Produced by: Cate Ryan and Colleen Cronin
Reporting contributed by: Emilija Sagaityte and Rahma Ibrahim
Sound engineering by: Cate Ryan
Special thanks to Elise Ryan and Bilal Ismail Ahmed for cover design and production assistance.
Music: "Investigation" by Chad Crouch via Free Music Archive. View Creative Commons License.
