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— Education

The Year We Were Schooled by a Pandemic

Pandemics are a recurring tragedy in human history, but they don’t have to be

From the Black Death and smallpox through malaria, measles, mumps, SARS and Ebola, pandemics have always plagued humanity. Each provided painful lessons, and the degree of pain is often a reflection of human error—the same errors of the past continued into the present now and the future tomorrow.
The COVID-19 pandemic is the latest, but surely not the last. Still, I was surprised in early March 2020 when Nancy Binkin, MD, my infectious disease colleague in the Division of Epidemiology, told me, “Life as we know it is over.”

I studied the first recognized U.S. outbreak of COVID-19 in a Kirkland, WA nursing home. It was reported on February 28th that a virus had infected 129 people and killed 23. This happened near my longtime former home in the Seattle area and in one of the most capable public health systems in the United States.

I listened to the public federal bickering on March 7th about whether Americans on a cruise ship docked in the Bay Area should be allowed to disembark to care for the sick and protect those still healthy, and the unconscionable consideration that everyone should stay on board so that U.S. numbers of COVID cases would not double.

On March 9, 2020 Wilma Wooten, MD, San Diego County’s public health officer, announced that the first local case of COVID-19 had been identified. Eleven days later, UC San Diego Chancellor Pradeep Khosla followed California Governor Gavin Newsom’s order and sent us home to quarantine in a major effort to flatten the curve of community spread.

In a few weeks, though, it became clear that community spread of COVID-19 had been going on silently in California and elsewhere for months, that the virus was spreading to every country in the world, that millions of deaths would occur, that vaccine development was likely the only way out, but widespread vaccination efforts were one to two years away — on an optimistic timeline.

In real-time, we saw that what was happening in Italy would happen in New York City and then in many other communities. We saw that we were woefully unprepared in terms of having adequate personal protective equipment for hospital workers, ventilators for the most seriously ill, accurate testing methods on a scale that would allow us to identify and isolate the infected, and the ability to coordinate a national or international response.

Our education by a modern pandemic had begun in earnest. I was beginning to understand the implications of Dr. Binkin’s prediction: There would be no aspect of population health, or arguably our daily lives, left untouched by the threat of COVID-19.

Before the emergence of COVID-19, on the 100th anniversary of the 1918 Influenza Pandemic, a special section in the November issue of the American Journal of Public Health was devoted to prescient reflections on the lessons learned and not learned during the past century.

These papers make clear that none of us should be surprised by the repeated history we observed in 2020. The accompanying editorial by Wendy E. Parmet and Mark A. Rothstein identified three leading attitudinal threats: hubris, isolationism and distrust.

These attitudes breed misinformation. In 1918, as in 2020, both pandemic viruses prompted all manner of misinformation, sometimes misguided, sometimes malign.

“The term “Spanish Flu” arose not because Spain was where the H1N1 flu virus originated, but because the Spanish press were among the only media permitted by their country to write freely about what was happening.”

Woodrow Wilson severely curtailed accurate reporting to Americans during the pandemic as a wartime measure when he signed the Sedition Act in 1918. It was repealed by Congress in December 1920.

In 1918, controversy existed about the usefulness and legality of face masks, which resulted in various pressure tactics by both sides of the debate. This led to San Francisco establishing a mandatory mask ordinance in October 1918 and an organized campaign against the law in 1919 by the Anti-Mask League of San Francisco.
A “public service announcement” published in the San Francisco Chronicle in October 1918 declared that “the man or woman or child who will not wear a mask now is a dangerous slacker.” I cannot help but wonder why solid research on the effectiveness of masking for the general public as a defense against viruses spread by respiratory droplets from person to person was so lacking 100 years later when Anthony Fauci, MD, director of the National Institute of Allergy and Infectious Diseases, first commented on whether we should wear them. Eventually, mask mandates during COVID-19 were followed by news reports of angry protestors storming grocery stores to demand an end to enforced masking.

A highly transmissible and deadly global pandemic will unmask every weakness in our larger society, but in public health, our research unveils these weaknesses routinely. Our raised voices calling out the harms of poverty, gun violence, lack of health care and all manner of oppression are largely ignored.

The same inequalities that influence nearly every aspect of our lives, from education and employment to housing to health care, to the safety of front line workers and care of our most vulnerable older Americans have been highly visible during the COVID-19 pandemic. Already burdened by myriad social and economic disadvantages, people of color, women and essential workers, from store clerks to bus drivers, struggled to survive — and many did not.

Black, Latino and Native American communities were disproportionately affected by COVID-19 and died at rates far above those of white people.

Clearly, in the column of unlearned lessons, we must confront the fact that we tolerate too many preventable deaths among our fellow Americans when we could do so much better. Pandemics hold a mirror up to our complacency.

We all have our personal stories about the pandemic, and these range widely. My adult children remained employed and took care of each other while we chose not to risk visiting until vaccinated. We watched our daughter graduate from her master’s program via Zoom. I worried about my sister in New York City taking the subway. We were informed that my mother, who has Alzheimer’s disease and resides in a memory care facility in White Plains, NY, had COVID-19. We placed her in hospice care.

At the time, there were no readily available COVID-19 tests, and hospitals were overflowing. Health care staff at the memory care facility were sleeping in the building to avoid spreading the virus. I was terrified when a faculty colleague was hospitalized for many weeks with severe COVID-19, complicated by MRSA pneumonia.

Miraculously, and thanks to the compassionate work of our health care providers, both my mother and colleague survived. As an epidemiologist, I am acutely aware and greatly mourn that hundreds of thousands of Americans died, that we will never know the true number, and that the deaths will continue, even as we see transmission and mortality statistics decline, across the state and country with rising vaccination numbers.

I also know that we in public health will spend the next several decades trying to understand the full impact of the events of 2020 on those of us who survived COVID-19 across the holistic spectrum of physical, cognitive, emotional and mental health.