We Asked 6 Infectious Disease Experts What's Changed Since The Pandemic Began
- The panelists
- Listen to the conversation
- Is the pandemic really over?
- The ongoing mysteries about COVID-19
- The current state of masking
- COVID-19 and mental health
- Burnout, shortages and challenges for health care workers
- The effects on kids and education
- Public health messaging woes
- Future of vaccines and antivirals
- How the pandemic changed the way they practice medicine
For the past three years, the LAist newsroom's public affairs show "AirTalk" — which airs weekdays on 89.3 FM — has dedicated hundreds of on-air hours to COVID-19 coverage. One of the ways AirTalk has been able to deliver this information is through a powerhouse roster of COVID-19 experts working on the frontlines who offered their time and answered your questions.
We brought the experts together for a special live event at Caltech’s Beckman Auditorium, and asked them how their lives have personally changed, what they’d change about public messaging looking back and how we use what we’ve learned to prepare for the next global health crisis — and much more.
- Dr. Dean Blumberg, professor of medicine and chief of Pediatric Infectious Diseases at UC Davis Children’s Hospital
- Dr. Peter Chin-Hong, infectious disease specialist and professor of medicine at the UCSF Medical Center
- Kristen R. Choi, professor of nursing and public health at UCLA and a registered nurse practicing at Gateways Hospital in Echo Park
- Dr. Shruti Gohil, professor of medicine and associate medical director for epidemiology and infection prevention at UC Irvine’s School of Medicine
- Dr. Robert Kim-Farley, professor of epidemiology and community health sciences at the UCLA Fielding School of Public Health
- Dr. Kimberly Shriner, director of Infectious Disease and Prevention at Huntington Hospital in Pasadena
Listen to the conversation
Is the pandemic really over?
Dr. Shruti Gohil: How far have we come? Peak after peak. We've seen this rollercoaster. Up and down. What's different now is that the deaths are stable. Hospitalizations are stable. And this is in large part due to the layers of immunity that have been achieved through vaccination and of course the infection itself. We're higher than what we like to see to call endemic, but we are stable and that's good.
Dr. Peter Chin-Hong: The number [of deaths] are still too troublesome for me, particularly given the tools that we have. The second thing is I don't feel that we're exactly predictable yet.
The ongoing mysteries about COVID-19
Dr. Robert Kim-Farley: The arising of variants and when the next one may arise. I think that's always a concern we have. And what will be the characteristics of that as it arises — will it evade our vaccine immunity or our natural immunity?
Dr. Kimberly Shriner: It's really a mystery as to what this virus does in the immune system, and that really seems to be the key of what creates the symptoms that people have. And of course, leading on to a really dreadful syndrome of long COVID, which we do see in about 30% of people who have had acute disease. This virus is very good at integrating itself into the immune system and the complexities of that, I think we're just beginning to understand.
Dr. Dean Blumberg: Why does this virus cause so much long COVID? We know that other viruses can trigger things like chronic fatigue, but it's so way out of proportion with COVID causing this long COVID.
The current state of masking
Dr. Shriner: I think that masking is a very easy, very safe, very effective way of protecting yourself from COVID. I think now we have to move into more areas where we can control the actual encounter with the disease. So it's important that the public understand when we toggle back and forth, wear your mask, don't wear your mask, it's in relation to what we think is circulating out there that masks can be effective and protect you.
Dr. Kim-Farley: I think that everyone is going to have to recognize their own particular situation. So if someone is immune compromised, they're gonna have to continue to be masking up. And I think the real important thing is for all of us to recognize we should not stigmatize. Some people, if they have something important coming up in five days or so, bar mitzvah or christening or whatever, they may choose to wear masks to make sure they don't get COVID at this time.
COVID-19 and mental health
Professor Kristen Choi: We do know that there is an intersection between mental illness and long COVID that we're still trying to understand, the reasons why these things happen together or why we see them.
It concerns me when I look at the rates of suicide, of depression and anxiety, especially among our teens and young people in the United States. But I worry, and it troubles me a lot, that we haven't quite learned the lessons we need about mental health from COVID yet in terms of our health system. So I still wanna see us go a little further there.
We had a fantastic discussion last evening at @Caltech w/ @UofCAHealth experts about how the pandemic has affected our lives & work in healthcare. Listen to the conversation today at 10a on @AirTalk. pic.twitter.com/8UxEUO4QES— Kristen Choi, PhD, RN, FAAN (@kristenrchoi) March 30, 2023
Burnout, shortages and challenges for health care workers
Dr. Chin-Hong: One of my colleagues and I went to the Golden State Warriors game with a group of trainees because we wanted to build that community, and the trainees didn't know each other by face because they only saw each other through masks. And there's so much physicality that you have and body language, so things are far from back to normal. People are operating out of mental exhaustion. There's a moral injury because we are still taking care of patients who aren't subscribers to some of the tools that we have to keep them safe. And that's hard.
Professor Choi: There were times when I contemplated leaving nursing and thought that my clinical career would end during COVID because of the conditions. I think that we have to look really carefully the drivers of our workforce shortage in health care and how we can tackle those things. And, people say to me all the time, Can we just train more nurses? The problem is that we have a shortage of nursing care and physician care because people are leaving because working conditions are simply not sustainable for people.
The effects on kids and education
Dr. Blumberg: I think we had to close the schools in retrospect, and that's based on what happened in New York City and India, and Italy. There are so many different places where the health care systems got overwhelmed and people were dying because there was a lack of supplemental oxygen. We couldn't allow that to happen, and we know that children can serve to amplify community associated infections.
So many kids just lost out on school experiences, not only the learning but the social experiences. The isolation that they experienced was severe. So there's a lot of catching up to do among children as well as teens. It's not only the younger children. For example, in medical school and the residents in training, they missed out on so much during this time because they didn't have interactive conferences in person.
Public health messaging woes
Dr. Chin-Hong: We had no idea, first of all, that we'd have so much misinformation and disinformation. This has been a pandemic of social media in many senses. Coming back to those early days, I think we underestimated in terms of messaging what that role of the other non-science based people would be. We had the false security that people would listen to clinicians, but that's not always the truth, particularly in minority and vulnerable populations. Having a clergy member or somebody from the community was probably more powerful than somebody from a health care facility at that point.
Dr. Kim-Farley: I think we failed in one sense of not setting people up that there is going to be change in our guidance as we go forward. It's a brand new virus. We're finding out more about it, and as we find out more about it, our guidance is going to change. Number two, the virus itself started changing on us with different variants. So I think that’s often in the minds of others as flip flopping, as compared to getting out ahead of it and saying, we're gonna have these changes going on.
Dr. Blumberg: I think we did lose control of messaging, in my opinion. We know that the three most important things for protection or masking, distancing and vaccination, And yet we did spend an inordinate amount of time talking about hand washing.
Dr. Gohil: This was a massive culture change. Masks didn't have the cache and clear data that it has now in terms of both community masking and hospital masking. The need for masks wasn't fully recognized, so I'm not sure it was a complete public health message to keep all the masks for our health care facilities as much as well, is it really our frontline of defense? And now I think all of us have come around to really recognizing it as [that].
Future of vaccines and antivirals
Dr. Shriner: We had the genomic information within weeks after the first outbreak in Wuhan and an effective vaccine using a 20-year-old technology that had really never been tried on a grand scale, was super effective. That happened within about eight months of the onset of the pandemic. That's an enormously important achievement. A lot of that was. On the backbone of the HIV pandemic.
Professor Choi: I think many of us have anticipated that this may become an annual booster that we all get going forward. I think that makes a lot of sense. I think we're at a place where this virus is something that we're seeing starting to stabilize. Knowing that, knowing the seasonality that there is, makes sense to me that we would potentially have a seasonal booster.
Dr. Chin-Hong: We know that the U.K. has allowed immune compromised individuals of all ages, and those of us 75 and in Canada over 80 to have the option of a booster before the fall. So that's a could rather than a should recommendation. So I think the FDA will probably respond to a lot of public pressure to do something similar, but you wouldn't probably see full-on population campaign until the fall.
Dr. Kim-Farley: Manufacturers are working on this two vaccines in one — flu and COVID. So I think we'll see that coming up too, which will make it a lot easier.
How the pandemic changed the way they practice medicine
Professor Choi: I have become personally more willing to spend time with patients and families than I was before. Time is what is most critical that we spend with our patients. The other piece though is that when people come and I talk to patients and families, I think so much more about their context and where they're coming from. One of the big things that this pandemic has helped us see is the way that we have so many upstream factors that have driven the inequities we see in COVID, and we've seen inequities from day one. And who is getting infected, who can access vaccines, who can access treatments. The same groups have disparities and don't have equal access to care.
Dr. Kim-Farley: We recognize now we've got to be more and more prepared for potentials to occur. We are moving into areas in the world that have been previously uninhabited. We've got transportation systems that in 24 hours you can be anywhere else in the world. We are all interdependent.
Dr. Gohil: The borders of our hospitals are really not the borders. We are part of a huge community of people and we are accountable. Everything that we do in our hospitals really should think about the total care of a patient from the beginning all the way through their discharge and their wellness.
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