0:00

It's clear that for many people SARS CoV-two

0:02

infection no longer carries the same

0:04

risks of adverse outcomes that it did

0:07

in the early months of the pandemic. But

0:09

it does seem likely that the virus will continue

0:11

to play a major role in our lives for the

0:13

foreseeable future. This new reality

0:15

compels us to navigate complex social

0:17

economic political and clinical terrain,

0:20

and to consider the lessons that we've learned

0:22

from the COVID response so far. I'm

0:25

Stephen Morrissey, Managing Editor of The New England

0:27

Journal of Medicine. And I'm talking

0:29

with Wafaa ElSadr, the Director

0:31

of ICAP at Columbia University. Dr.

0:34

Elsado has co authored a perspective article

0:36

about the next phase of the COVID-nineteen

0:38

pandemic. Dr. Alsett, are you right

0:41

in your perspective articles that there's

0:43

a widespread assumption that the COVID-nineteen pandemic

0:45

is behind

0:46

us? It's time to resume pre

0:48

pandemic life. How do you see this

0:50

current moment in the pandemic? Well,

0:52

I do think it's a critical moment

0:54

in the trajectory of the COVID-nineteen

0:56

pandemic, because I think for many people,

0:59

they really are desperately seeking

1:02

what many call return to normalcy,

1:04

meaning that sort of the belief or hoping

1:07

that the pandemic is behind us

1:09

and that we can resume life as it was

1:11

before the pandemic. And

1:13

I think for people in the public health

1:15

world or in the health world overall,

1:18

I think that, of course, it conflicts

1:20

with the reality of where we're

1:22

at in terms of COVID-nineteen at this

1:24

moment in time. We know that this

1:26

pandemic is still with us. We

1:28

know that for the foreseeable future, we're going

1:30

to continue to see cases and transmissions

1:32

of SARS CoV-two, and that we

1:34

will also, in our likelihood, see new

1:37

variants of SARS CoV-two, that

1:39

resulted in some surges in the numbers of

1:41

cases and associated morbidity

1:43

and mortality. And therefore, we

1:45

need to somehow navigate and provide

1:47

guidance to the population at

1:49

large at a moment where the

1:51

population is in a very different place.

1:54

So you say in your article that current situation

1:57

requires a different response than in

1:59

the early days of the pandemic, including

2:01

when it comes to monitoring the effects of COVID-nineteen.

2:04

So how is monitoring more complicated than

2:06

it was two or three years

2:07

ago, and what measures are most useful

2:10

now? I think traditionally when

2:12

we think about COVID-nineteen, we've

2:14

used measures like, for example,

2:16

the of cases, transmission

2:19

rates, the hospitalization rates,

2:21

mortality rates, These have been the

2:23

metrics that we have traditionally used.

2:25

We've also used as well some health system

2:28

utilization data like numbers of

2:30

ads occupied by COVID-nineteen cases,

2:33

intensive care unit beds, patients

2:35

are ventilators and so on. So we've been

2:37

monitoring this pandemic largely depending

2:39

on what I call clinical and

2:41

health systems metrics overall.

2:44

For some of these, it's become much more complicated.

2:46

We know for example that at least in

2:48

countries where self testing is widely

2:50

available as in the United States

2:53

that often people who are diagnosed through self

2:55

testing, through home testing, they

2:57

often and the majority do not

2:59

report a positive test result,

3:01

for example. So counting the numbers

3:04

of cases becomes of limited value.

3:06

We still can use, of course, hospitalizations, although

3:09

we know, of course, that that's a late

3:11

consequence of a COVID-nineteen case.

3:13

And of course, mortality can still be

3:15

a metric that we can follow. But

3:17

all of these as well have their own complexities,

3:20

for example, even counting hospitalizations

3:23

that are people are hospitalized due to

3:25

COVID, but there are also people who are

3:27

tested for COVID at the time of hospitalization

3:29

and a positive test is an incident

3:31

are finding. So there are these limitations

3:34

that we are seen now to the traditional

3:36

metrics that we've used before.

3:38

At the same time, we also have learned

3:40

so much more about COVID-nineteen and

3:43

what we urge my co authors and

3:45

myself in our paper is

3:47

considering the broader impacts

3:49

of COVID-nineteen on societies and

3:51

people in societies and communities. And

3:53

taking into account some of those metrics

3:55

as well. And this gets at issues,

3:57

for example, in terms of the impact

3:59

of the pandemic, in terms of income

4:02

for various individuals, the

4:04

impact in terms of livelihoods, the

4:07

impact in terms of housing and ability

4:09

to pay for housing, the impact in terms

4:11

of jobs and ability to actually

4:14

work during the time of a crisis,

4:16

as well as the impact on the lives of children

4:18

and the movement towards transitioning

4:21

to virtual education and the

4:23

impact on children and particularly

4:26

children from vulnerable communities So

4:28

what we're advocating for is

4:30

a broader look at the impact

4:32

of COVID-nineteen overall, not just

4:34

the clinical impact, but

4:36

also the broader society's impacts

4:38

that often are primarily felt

4:41

by most vulnerable communities around

4:44

the

4:44

world. In your article, you highlight the

4:46

current need for a differentiated approach to

4:48

COVID-nineteen rather than universal

4:50

recommendations. So can you explain

4:52

what such an approach might look like

4:54

and talk about the challenges that are involved

4:56

in tailoring guidance for specific

4:58

populations. Yes, it certainly

5:00

is one of the challenges we're facing

5:02

now And this is based on what we've learned

5:05

about COVID-nineteen. For example, we

5:07

know that the impact on a certain

5:09

community is often driven

5:11

by factors like the age

5:13

distribution in that community, the

5:15

prevalence of co morbid medical conditions

5:18

in a community, the vaccination rates

5:20

and booster dosing rates in

5:22

that community per se, that socioeconomic

5:25

status of the community. So I think

5:27

there are all these factors that

5:29

really have a huge impact in terms

5:31

of transmission of the virus,

5:33

but also in terms of the consequences of

5:35

COVID-nineteen. And these factors

5:37

should help us to tailor

5:39

what we do and what the guidance we

5:41

provide to these various communities.

5:43

So I think what we do and

5:46

what we say in a community where

5:48

the impact in terms of the clinical impact

5:50

is going to be profound, may vary

5:52

substantially from another community where

5:54

We know that the impact is likely

5:56

not to be as severe. We also need

5:58

to guidance to take into account whether

6:01

what we are advising people to do

6:03

is feasible. Do they have access

6:05

to masks, for example? Do

6:07

they have access to treatment? And

6:09

so on, do they can access the vaccines?

6:12

Because all of these Factors

6:14

can also really very

6:16

much influence whether the guidance

6:18

can be followed by the target

6:20

population. So I think taking into

6:22

account where people are at, their

6:24

own circumstances in terms of

6:26

their own clinical situation, their

6:28

own access to house resources their

6:31

own socioeconomic conditions and

6:33

status. I think all of these are factors

6:35

that should guide us in

6:37

terms of the types of guidance that we

6:39

provide to these communities

6:41

and even more importantly, how

6:44

we provide these guidances.

6:46

What lessons do you think have been learned from

6:48

the politicization of COVID nineteen? And how

6:50

do you think challenges

6:51

related, for example, to misinformation?

6:54

Could be addressed during future public

6:56

health responses. There have been many,

6:58

many, many lessons and hard lessons

7:00

from COVID-nineteen, and I do hope that if

7:02

we take stock of these lessons

7:05

that can help us to not only

7:07

respond to the next health challenge, but also help

7:09

us in responding to COVID-nineteen as we

7:11

move forward. And I think one of the hard

7:13

lessons we've learned is the importance

7:15

of communicating and communicating

7:17

go out. That's really critically important.

7:19

And that means in terms of the messages

7:22

themselves and how we tailor

7:24

those messages based on the

7:26

target population that wants are expansive

7:28

in their own realities, but

7:30

also in terms of who delivers

7:32

the messages. And that's been a

7:34

very important lesson that we learned.

7:36

We have to think very carefully

7:38

about how do we recruit the

7:41

champions within the most

7:43

vulnerable communities. How do we

7:45

find the people who are trusted by these

7:47

communities and engage with them

7:49

and engage with them early, not during

7:51

the moment of the crisis, not during the

7:53

moment the pandemic, but engage

7:55

with them a priority so that

7:57

they feel that they are part of the

7:59

system. And they become informed

8:02

and they are part of their communication

8:05

tools and communication channels

8:07

that we use when we face a crisis.

8:09

And I think we've learned that the hard way

8:11

with COVID-nineteen is that we

8:13

were late in really realizing

8:15

the importance of community engagement,

8:17

the importance of finding those champions,

8:19

those trusted spokespersons, and

8:21

the importance of engaging them in an

8:23

ongoing way so that they

8:25

can help us during the

8:27

times of crisis.

8:29

Finally, how can public health leaders

8:31

and policymakers both acknowledge that

8:33

we're in a better place with regard to COVID-nineteen

8:35

than we've ever been? But at the same

8:37

time, underscore the need for continued

8:40

vigilance. How do we get the messaging right?

8:41

Well, that's a very tough question. And I

8:43

think it's something that public health has

8:46

struggled with forever. And I think

8:48

that it's really important that we

8:50

acknowledge that we are in a very different

8:52

place. And therefore, avoid

8:54

at all cost these alarmist

8:56

types of messaging. That's

8:58

really important. We know that we are in

9:00

a different place. Thankfully, are in different

9:03

places. So acknowledge the tools

9:05

we have now at our fingertips, acknowledge

9:07

that we know a lot more, acknowledge the

9:10

mistakes we've made, acknowledge the essence we've

9:12

learned and then tailored these

9:14

messages and utilize the communication

9:16

channels that I described before

9:19

if more effectively in terms

9:21

of trying to communicate during

9:23

times of crisis, and I think that's

9:25

the balance that we're seeking in public

9:27

health. Is to provide

9:29

accurate information, to tailor the

9:31

information to the audience, to the population

9:33

at risk, at the same

9:35

time, to be able to listen very

9:37

carefully to the concerns of

9:39

these communities and to be able to

9:41

engage their own community

9:43

members to help us in

9:45

communicating back to them

9:47

regarding the necessary measures

9:49

that need to be taken to protect such

9:51

communities. Thank you, Dr.