Paula Lantz, associate dean of the Ford School and James B. Hudak Professor of Health Policy, and Michael S. Barr, dean of the Ford School, will discuss the emerging social epidemiology of COVID-19 and current understanding regarding public health and social policy responses. June 2020.
Transcript:
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>> It's a great pleasure to welcome all of you to this virtual policy
talks at the Ford school event with my colleague Paula Lantz,
Associate Dean of the Ford school and James D. Hudak professor of
health policy.
I think Jim and Sally are online now so I wanted to pause and say thank
you and hope you enjoy the discussion this afternoon.
This afternoon Paula and I will be talk about an emerging social
epidemiology of Covid-19.
And some of current responses to the pandemic by state officials,
public health experts, and policy makers.
We'll also be discussing the clear inequity that have been further
revealed bay virus in United States and inequities along long standing
racial, economic and social lines.
Let me briefly introduce Paula Lantz.
In addition to serving as the FORD school of associate dean for
academic affairs, and a James D. Hudak professor of health policy, she
also holds a joint appointment of professor of health management and
policy in the school of public health.
In recognition of her influential scholarship and policy engagement,
Paula is an elected member of both national academy of social
insurance, and the national academy of medicine.
She's also a beloved member of the Ford school family.
She positively influences almost everything that goes on in the Ford
school.
I'm looking forward to talking with her today about such an important
topic.
Before we dive into the discussion, let me give you a couple of notes
about the format.
We will have some time towards end of the event today for audience
questions.
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If you ever watching on zoom, please use the Q & A function at the
bottom of your screen to send us your questions.
We hope you'll also use zoom chat to engage in a conversation about at
discussion with your fellow audience members.
It's a great way to engage with each other.
For those watching the live stream on other social media platforms,
please tweet your questions and comments to us using #policytalks.
And without further adieu welcome Paula.
It's really nice to see you.
>> Hi Michael.
Nice to see you as well.
Through the computer screen.
>> Through computer screen as many things are today
>> That's right.
Let's get started just with a general sense of what is it about this
novel Coronavirus that.
Has led to a global pandemic in such a short period of time?
Really, all across the globe.
What is it about the science of this and the epidemiology of this
that's led to such rapid, rapid change in such a short period?
>> Great.
Great.
Great question to tart weapon before we dive in I actually do want to
say that it's a nice opportunity, not going to say this will be fun the
entire discussion, but it's a nice opportunity to be talking with you
today.
And with our community about what is really the biggest public health
crisis in many of ours lifetimes.
For summer I also want to annually that there are likely many people
participating in our webinar today who have experienced Covid-19 them
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selves or have had a family member or a loved one get this illness.
And, it can have very serious consequences.
Some people might have even lost a family member to Covid.
I want to start by acknowledging that this pandemic has affected all of
us socially, economically, in terms of our day-to-day lives, but also
likely affected some people health wise as well.
So again, it really an important topic to be talking about.
So the disclaimer going into all of this is that this is a novel
Coronavirus.
So it's new.
And the virology of it, epidemiology, the understanding it from a
medical point of view is all still evolving day by day.
I think now many, many people in the world now kind of know it
epidemiology is.
That wasn't the case before lots of people now are arm chair
epidemiologists which I think is great.
There's because there lot to know and understand about this we can
understand what happening in our communities and in our lives.
But again, a lot of this science is emerging.
What is understood right now is that you really couldn't if it was
intended, design a better virus for a pandemic.
Right?
So here we have a virus that can spread from person to person from
someone who has it and doesn't ever even have any symptoms.
They are asymptomatic.
Even though they have the virus and but no illness with it.
Also, people can get the virus and then spread it to others while they
are in a presymptomatic phase.
And that can last up to 14 days.
In some cases it appears perhaps even longer that people before
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symptoms appear.
Again people are infectious they can transmitting to others.
Many people who get COVID-19, COVID-19 is disease that is caused by the
Coronavirus.
Many people can get Covid-19 but not really even feel sick enough to
stay home, to stop interacting with family.
And so all of those things are bad.
They are bad for community spread.
Then also we know that we're still trying to figure out exactly what
the reproduction rate of the Coronavirus is the novel Coronavirus virus
epidemiologists here I will get a little technical but again we're all
arm chair epidemiologists.
Epidemiologists when they are looking infectious disease out break want
to understand what is referred to as the basic reproduction rate R-0 or
R naught in math terms.
Basically A reproduction rate of infectious disease if person has it
how many other people on average in a population will catch that virus
or that infectious agent from someone else?
So influenza or average influenza reproduction rate 1.3.
Anything over 1 is going to keep growing in the community.
We need to it get reproduction rate under 1.
That's only way a virus or other kind of infectious agent with
community spread will difficult out in a population.
>> If I have and I give it to other people it will keep spreading.
If we can get fewer people if I give it on average to maybe half a
person
>> Right.
Right.
>> Then the rate will go down.
>> Exactly.
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We need to get it under 1.
If it is over 1, that means there's growth and then there's always
exponential growth.
Influenza is 1.3.
And then with influenza people are often really sick pretty much right
away.
They take to their beds they stay home they are not out in the
community.
Measles has a basic reproductive rate 11 or 12.
So that's terrible. Measles is super, super contagious.
What we understand right now for the novel Coronavirus we don't know
what basic reproduction rate.
Is estimated between 2.8 not good and maybe even up to about 6.
But even let's take it towards the lower end.
Again that's bad.
So again the stars all aligning in a horrible way.
You've got something that fairly contagious that can reproduce pretty
easily in community for all reasons that I talked about.
And also when you're in that situation you don't have vaccine, and you
don't have super effective medical treatment for the people who get
really sick from it, that is just the horrible, terrible situation that
the world finds itself in right now.
>> Paula I think you have a picture you want to show us about or chart
about what the growth rates look like in the U.S. and world, that is
something you want to share with us?
>> I don't have a chart but I do, if Chris would pull up the slide
number 2.
Which is a table.
Any chart will show exponential growth.
So let's go yeah.
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So that chart.
So where we are in the world right now and mind you that the first
known cases of this novel Coronavirus appeared back in December.
Not even six months ago.
So we're, this was as of June 15th a couple days ago.
So we're at about 8 million known cases.
And 434,000 at least deaths.
Both of these numbers are seriously underestimated let's me be clear
about that.
Right now, the United States has the terrible distinction of being the
country with the highest number of cases and also if we put that into a
rate per population, we're even worse.
Right?
Because we don't have largest population in world we have largest
number of cases.
Largest number of deaths right now.
Brazil is in the second place for this.
It's growing very fast in Brazil.
You can see the numbers there.
Michigan, we are these numbers couple days old we have hit 60,000 cases
in Michigan.
We're a little bit over there and we're approaching 6,000 deaths.
The first case in Michigan was diagnosed on March 10th.
That is not I know it feels like an eternity to all of us, March 10th
seems like a long time ago.
But it really wasn't this is devastation it has done in this amount of
time.
We can talk about what it might have looked like under some different
policy emergency orders.
Vietnam I put on the slide for a number of reasons.
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One Vietnam is a country that has the same population as Michigan.
About 10 million people in Vietnam.
Also a country it borders China.
When virus first appeared in China.
Countries in Asia and especially countries that border China like
receipt knack were very concerned and took immediate action.
We could talk whether you want to believe these numbers or not I will
tell you actually do believe that Vietnam has had very few cases.
To date they've had 0 deaths from Coronavirus.
So it is
>> There developing country, we're rich edge countries in the world
we're going to talk a little bit about why we Venezuela able to wrap
our arms around this and maybe, you know one avenue into that is to
look at a stage that did and didn't take aggressive action in response
to the virus.
So you know there has ab huge amount of controversy about the way in
which Michigan put in place pretty strict orders
>> Exactly
>> To limit the kinds of interactions we have with each other to try
and you know reduce the infection rate, reduce transmission rate below
1.
How effective have they been?
Have they been effective enough how do they compare to other states?
>> Right.
>> We have national policy on this right now.
>> So need states do wildly different things how has that turned out?
>> Well, when states do different things countries do different things
it actually give nerdy policy analyst like all of us at the Ford school
the opportunity to use natural experiment research designs to try to
you know really understand what has been the impact of these things.
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I do want to back up for a minute and just say that there in history of
people, there have been a number of bad infectious disease out breaks
in the past.
Right?
And there has actually be a fair amount of research regarding what and
when we have infectious disease out breaks with community spread so,
person to person when people are just out living their lives, what are
the kinds of things that we already knew going into this pandemic are
the kinds of things that work?
A big heading of those things is called technical term, but people use
it it's nonpharmaceutical interventions.
These are the public health tools.
What does that mean?
Again when you don't have a vaccine you don't have effective medical
treatments you need to look to these nonpharmaceutical interventions
that are given to populations.
They are not given to individuals like a medicine or a drug.
They are given to populations.
Nonpharmaceutical interventions include these buckets of things one is
a healthy bucket of public hygiene measures.
So cleaning surfaces, wearing masks, people wearing masks in public.
Staying 6 feet apart.
Washing your hands.
All of sorts of things are in public hygiene bucket.
And they generally work with most kinds of infectious disease to quash
the person to person spread.
Social distancing measures are the big other really big bucket of
things.
So stay at home orders.
Closing schools.
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Banning large gatherings.
Closing nonessential businesses.
Closing public spaces.
All of these things we know from pretty good research that was done
through the influenza pandemic back in 1917 and 1918 through the pole
Leo epidemic that world faced in the past.
We know that these things are really important and they need to be put
in place they need to stay in place long enough to get that community
spread down below that 1 number.
There's also another bucket of things mobility restrictions.
Right?
Which we most actually most states haven't put them in place.
Some have but mobility, mobility restrictions you know travel into a
jurisdiction, you know travel out.
If you're going to travel in, you need to under quarantine.
Quarantine public health word for when people who aren't sick have
their mobility restricted.
So if you're under quarantine you're not sick but you're not allowed
to, you know in this case a lot of for Hawaii for example, if you
wanted to go to Hawaii right now which sounds kind of good, if you went
to Hawaii you would have to spend two weeks in quarantine before you
could go out into the community.
Isolation is another public health tool that, so people who have
symptoms or people who have been exposed to someone with a disease or
as asked to isolate so stay away from other people.
And there are public health laws actually that can force people into
quarantine in isolation.
Really restrict people's movement.
We haven't seen that much inspect states in terms of that.
A little bit but not a lot.
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Really public hygiene method and social distancing methods.
So what do we know about the impact of that?
Let's start with Michigan.
So Chris, if you could bring up slide number 3.
So this slide shows the results of some modeling work that has been
done by colleagues of ours here at the university of Michigan in the
school of public health.
Professor Emily Martin and Marisa Eisenberg.
Have led a team that really looking at you know what, what would we
expected in Michigan in terms of the Coronavirus outbreak.
And then what did we observe with social distancing.
So what would we have expected without it and what did we observe with
it.
This is a basic tool that comparing expected and observed.
We do that a lot.
And so the modeling for Michigan you've using lot assumptions assuming,
reproduction rate, effectiveness of these sorts of things.
And then using data the daily data that is generated in state and made
public, the conclusion as of June 1st was that without the social
distancing measures that were implemented in the state of Michigan, we
would have likely seen 28,000 more cases of Covid-19 in the state.
And probably about 3500 more deaths.
And it
>> Dramatic.
Sounds like pretty the stay a home ad pretty dramatic effect in
reducing the reproduction of this virus?
>> Very dramatic.
Very dramatic effects.
And it's, its not just sort of you know, home grown people at the
university of Michigan who have come to this conclusion.
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If I could have next slide as well up there.
There is so that would slide number 4.
Great.
A group of researchers at the new imperial college in UK who are really
looking at what's going on in the world with Coronavirus, and what has
been the impact of government emergency orders on the virus on it's
spread, and on deaths, et cetera, across the globe.
They released a report last week that looked at what was happening in
United States.
And they actually gave a great thumbs up to great lakes region of the
United States saying we are in the great lakes region doing a very good
job at flattening that curve and containing the virus.
They gave special props to Michigan.
And this, this chart shows that the, this is seven-day average of newly
lab confirmed cases.
It shows it's going down.
And another thing that this study determined is that they think right
now in Michigan, we actually do have the reproduction rate below 1.
That's why all social distancing and the public hygiene measures what
they need to do is stop that community spread, stop the average number
of cases from person to person.
And if we can get that below 1 and keep it below 1, we'll be okay.
>> Obviously there around lots of trade-offs you know, that states are
making between thinking about when to open up and getting that R below
1 is so key.
Are you nervous at all that as we begin to see changes in policy that
number will go back up?
>> Very nervous.
I'm not I'm not going to I'm not going to sugar coat it at all.
I'm extremely nervous about this.
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I'm sure all of you reading a lot news reports a lot of concern about,
you know, second waves.
There's concern about surges.
There's concern about second waves in places that haven't even finished
their first wave.
But you know, today, today in the news there is concern about a number
of states that have opened up and are seeing increases.
Not just sort levelling off but increases in the number of cases and
the number of hospitalizations.
It's a little early to see the number of deaths but in some places
those are, those are rising as well.
That includes states like big states, Texas, Florida
>> Arizona, Arkansas and North Carolina and South Carolina are the six
states that getting a lot of attention but we think this is happening
in other places as well.
Now what you hear a lot and unfortunately all of this has become super
politicized, right?
So what you're hearing a lot in the press too is like well, the number
of cases is going up because we're doing more testing.
And that's absolutely true.
The more and I mean it's a fact.
More any kind of disease, any kind epidemiology or healthcare
situation, you know, the more you go around looking for around disease,
the more you're going to find and cases are going to go up.
So that, that could be explaining part of it.
But what you really want to be watching is you know 7-day averages in
terms of cases.
What are those doing?
And then also what's happening with hospitalizations and deaths.
That's where we need to be worried.
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In awful those states the trends are really quite, quite alarming.
Quite alarming
>> Another really disturbing fact of the Covid-19 crisis is that it's
really reinforced laid bear all the racial and economic social
inequities in our society.
They are reinforcing the impact of the disease both who gets it and
then what the outcomes are for people who get it.
Just much, much worse for African Americans.
I know in Michigan, 14 percent of the population is African American.
And 40 percent.
Of the deaths from Covid-19 are hitting African Americans.
I wonder if you could just help us unpack that, what's going on, why is
it happening let's just start with that and then we can think about the
next question which what to do about it
>> What to do about it, right.
>> Just complete the picture and what's going on and why?
>> Sure I have couple slides about that that I think will help our get
our conversation going.
So slide number 5, please.
The social epidemiology of Covid-19.
And I think while, you know everyone right now is an arm chair
epidemiologist.
I think more people are also become arm chair social epidemiologists
which I love as well.
Because I think it really, I think people are really understanding how
every kind of outcome in our society education outcomes, economic
outcomes, health outcomes are all patterned by socioeconomic status, by
race and ethnicity, and the way in which everyone in our society
interacts with all of our social structures in our systems.
And that's what social epidemiology always looks like.
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Always looks at.
So first of all what do we know, what are the individual level risk
factors for Covid-19 exposure?
We do need to start with that.
Right.
So who is being exposed?
Who had high risk of being exposed once exposed who has higher risk for
serious illness and death?
>> Let's just start with that.
We do know people who live in congregate living situations like nursing
homes, rehab hospitals psychiatric institution and people who are
incarcerate have higher risk for getting Covid.
I just do want to give some numbers to you.
Nationally, 44,000 people who are current incarcerated have gotten
Covid.
462 have died.
Those numbers are just going up and up and up and up.
Some states that are seeing a rise in Covid right now a big part of
that due to it the increase in are both nursing homes and prisons and
jails.
There's certain occupations obviously where people are more likely to
be exposed to the virus.
Then get the disease from it healthcare workers, first responders,
other kinds of front line service workers.
People who work in meat packing plants, et cetera.
Then also, CDC has all of their guidance for what all of us as
individuals can do, wear a mask, wash your hands, do all of that.
But some people just can't, they are not able to not because they don't
want to, but because of their structural situation Arndt able to follow
the sort basic hygiene advice.
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You know it's hard to wash your hands if your water has been shut off,
right?
It's hard to stay home from work if you are reliant on that income you
don't want to get evicted you don't have paid sick leave.
You're relying on public transportation, et cetera, et cetera.
So, exposure are, I don't know a lot of people talk about viruses as if
they were great equalizer among us.
Viruses don't have biases, viruses aren't racist, viruses there
discriminate.
That but there are many, many things about our society and our social
structure that put people at different risk levels for exposure.
So we've got to understand that first.
And then, once exposed, and getting Covid, their risk factors for
serious illness and death.
So it's very, very clear, doesn't matter what country you're in if
you're older and age 65 or older, you're going to have much harder time
with this virus.
So age in of itself is an issue.
But also, people with certain chronic conditions are really getting
very, very sick.
Much the people who are most likely to die from COVID-19 and a chronic
conditions a like lung disease asthma hyper dense, diabetes, chronic
kidney and liver disease, and if you are immune compromised that's not
a good thing either.
But also can pull up the next slide?
So we know that racial and ethnic minority status is definitely a quote
a risk factor.
I don't know if everyone can see I can't quite see the whole slide
here.
Let me read the numbers to you.
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A study actually just came out by Brookings institution that said, a
lot of states Michigan include Michigan was one first states to start
reporting Covid cases by race and ethnicity.
I'll note if you just look crude rates by 100,000, nationally it looks
like the rate of getting Covid is 54100,000.
I just got a notice my computer is at risk for a virus.
So --
[ LAUGHTER ]
>> I will have to turn that off.
Not Covid.
So 54 per 100,000 for black people in the U.S.
26 for Hispanic, 26 for whites.
But, different populations have different things.
It's a little easier to read have different age distributions.
If you have a population that has an older age distribution you're
going to see probably you know more cases verses a younger age
distribution.
Well it turns out that, the age distribution for blacks and Hispanics
in United States is a little bit younger than for white.
If we adjust four that, the rates of Covid are even worse.
Than we thought just look crude numbers.
It's 72 per 100,000 for blacks, 50, this a death rate, 50 for Hispanic
20 for white.
You see it's almost
>> Huge, huge different and disparities.
>> Yes.
It's worse than we thought.
So were not surprised.
But again it's um, it's worse.
So, Chris you can take the slides down, please.
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>> I mean there are so many different ways to think about this why is
this happening?
But, again from the social epidemiology point of view and a social
scribes and policy point of view importantly, we need to not explain
oh, black people are dying more from Covid because they have more
chronic health conditions.
Let's back up.
Why is that the case?
Why is it case that rates of diabetes and hypertension and obesity
actually turns out to be a risk factor as well?
Why?
Why are certain people in our population first of all more likely to be
exposed and have a harder time with it?
And here's where we really need to look at again those social
structures that structure access among people to resources and
opportunities and privilege and also structure being exposed to risk
and disenfranchise of communities and discrimination can.
I'll stop see how you want to take this.
No, you just absolutely central topic.
One of the things you highlighted is, the way in which structural
racism in our society means that African Americans, Hispanics going to
die at much higher rates than whites from this disease.
There's also this structural issues that mean that our work in helping
to prevent spread is always disproportionately affecting the same
communities economically.
I'm wondering how you think about that.
>> There's so much going on.
I mean this is just basis of social inequality in our societies.
Which in our oath which is hard enough to think about and then let's
layer on Covid on top of it.
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Actually tried to put together a figure to help sort of talk about and
think about it.
Chris, if you could pull up slide number 8.
Here, so again the important thing for us to think about and understand
is that these, the Macro level systems in institutions and public
policies that are in place that drive socioeconomic and racial
inequality in the first place are the root cause of health inequities.
And, so we start with that.
We have economic political social racial inequality in this country.
That drives every form of health inequity.
What I spent my entire career studying from what drives infant
mortality disparities, what drives lead poisoning disparities.
What drives cancer.
I mean all of upstream Macro level factors.
Story just keeps playing out over and over again.
So it's playing out in terms of Covid-19, in terms inequities in
exposure and outcomes but Michael as you rightly just noted, those
nonpharmaceutical interventions those emergency controls that we have
to put in place stay home.
Don't send your kids to school.
We're all on lockdown.
Have, it's just the it's worst catch 22 ever, right?
Those things are also hitting people in minority communities lower
socioeconomic communities much, much harder than other people.
So it's, people have been talking about this and inn lot of different
ways.
And scholars you know have been working on racial and ethnic inequities
in health for a long time are you know talking about this as you know
using terms like I agree with all of these, you know, the Covid
pandemic is just being pushed by a pandemic of structural inequality
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and structural racism.
A colleague I will read what she wrote this pandemic is creating chasms
where we already had large cracks.
And patient of what make larger cracks is the stay at home orders,
right?
So you know, let's talk a little bit about that.
My kids are grown.
They are not home I didn't have to figure out how I was going to you
know be home schooling my children while you know doing all other
things we've doing at the Ford school.
In response to the pandemic and to keep up with our teaching mission.
But, for people had to figure out how to do that at home.
When they might not even internet connection also think about how many
kids rely on free and reduced breakfast and lunch at school.
Food insecurity getting worse when we close our schools as well
education just as oh colleague an education policy expert noted
recently in "New York Times" piece, that basically school ended in
March for most kids.
But this just going to you know, even further take that crack in our
educational system and make a bigger chasm
>> Paula, let's switch gears a little bit and think about how are we
going to climb out of this?
What are the, what are the steps, I mean obviously a lot of steps we
need to take.
But when you think about the key steps that are going to help us both
with the virus and with underlying racial injustice involved in
transmission and treatment of the virus how are we going to begin to
climb out of that as a country?
>> So it's -- again I'm not going oh sugar coat this because it's just,
same ways that many of have been argue we to climb out of health and
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inequities in general forever.
It's not, it's not easy.
Right?
So in first response to this pandemic, we obviously need to figure out
ways to give people income security and support unemployment insurance,
food security, healthcare access, I mean there's all of these kinds of
things.
I don't really want to call them band-aids because they are really
important we're bleeding everywhere.
We've got to have a good response to make sure people aren't being
evicted and foreclosure rate what's going to happen with that.
Again food security economic security.
All of those kinds of things.
We need, we need strong government response to that.
But also because our systems in general let so many people living on
the edge.
Michael you probably know more than I do, what percent of families
households in this country can weather an economic shock of more than a
month?
>> Yeah.
Not many.
>> Not many.
>> Right.
You know there's data on housing afford ability that demonstrates where
housing crisis is in country is getting worse and worse.
There are very few places where someone making the average wage in at
community can afford to live pay the average rent for a two bedroom
house.
So, there, and then healthcare, I think everyone knows it's a mess.
Right?
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Rates uninsured are going back up.
Can healthcare safety net has giant holes in it.
So, there are many that things need to be done you know immediately to
stop the hemorrhaging.
But if we don't get our systems in place, if we don't think more about
social and economic security for people, and again if we, if we don't
do something about this systemic racism that puts communities of color,
and, left many, many urban areas almost abandoned except for pockets of
gentrification.
If we there do something about environmental racism and think that
everyone should have access to what world health organization calls
basic materials of health, food security, clean water, clean air,
housing security, a physically safe environment, if we don't do better
on those things, as this virus the way it's crests and go up and down
probably what will happen when another pandemic hits us we will be in
same situation.
>> Paula I'm going in a moment start to weave in questions from an
audience we've getting before I do that let me just ask you know you've
doing a lot of research and response to Covid-19 crisis.
Really struck by the number of Ford school faculty as a whole who have
really engaged step up with their own research, with engaged learning
opportunities for students, engaging in policy impact and world I'm
wondering if you just maybe paint a picture for us of that and give us
some examples of what Ford school community has been doing.
>> Well I'm happy to give a couple.
I know Michael really know about all of these things as well so you can
share some of the highlights yourself.
But I think you know, the Ford school is a community, our mission is
we're a community dedicated to public good.
And to no surprise to every here everyone pivoted very, very quickly.
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In terms of what you know they are working on to not pivot to now look
at Covid, but understand how this pandemic is again so related to all
other things we do at the Ford school.
People worried about climate change in the environment.
Very worried about what this pandemic is doing in that regard.
People worried about education.
Social welfare policy.
Et cetera.
So just a couple of highlights.
So my colleague thinks about science technology and public policy
issues.
And she with lightning speed wrote a grant got some money from National
Science Foundation to study what's happening in terms of the
development, implementation and regulation of diagnostic test for poor
countries.
That's exciting work our colleague Luke Shaefer and all of the amazing
people he works with at poverty solutions here at the university of
Michigan are looking at the impact of Covid on social welfare of people
here in Michigan.
And you know, what's happening in terms of poverty rates unemployment
rates, food security, et cetera.
Luke and other have been advised state government of Michigan in regard
to how quickly get employment benefits unemployment benefits out to
people.
Which is huge issue obviously on economic side of things.
Our Ford school economists like Justin and Betsey Stevenson have been
on television and writing in a lot of news about again how do we climb
out of this economically.
I will say that if you've heard Betsey and Justin and many other
economists they all are I'm glad to hear sounding you know quite
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vocally in unison that if we don't get virus under control we have no
hope of getting economy back on its feet.
So, the idea again of opening up letting people show go to restaurants,
having gatherings spend money, spend money to get people back working,
that's great.
But, if we do that and virus spikes again, it's not going to help with
the economy.
Right?
>> That leads me right to beginning of some of our audience questions
we have quite a few coming in we will we will try to clip through them.
One question is when a region reach as basic reproduction rate below 1
like Michigan is now can we assume fewer social distancing measures
make sense?
If so, how do these regions then protect against the second wave?
How can policy effectively affect the pace of reopening?
>> Right.
Million dollar question.
That's an excellent question.
So basically, unless that reproduction rate is way below 1, you're
going to have be very vigilant.
You know, Michigan is opening up slowly.
And that it is, that's right way to do it.
Open up slowly and then, keep your eye on the data.
What's happening.
If things start going up again, we might have to pull back on you know
some of the that things we're being allowed to do.
But if you pull away all of social distancing measures overnight and
everyone just goes out and is there their wonderful self again out in
the world, that I think without any question, again we don't know, this
new virus, but I think without any question that's going to lead to a
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second wave or another spike.
You know, again I think we're in for multiple waves.
I think it will be this it goes up let's contain it quickly.
You don't and it gets way above 1.
You get it back up to you know 3 or whatever, then it's much harder
than we all have go on lockdown for much longer.
So, again, the I think the trick will be this is Governor of Michigan's
approach.
They will watch the data.
And try to be very careful about opening up and then again might have
to pull back.
And that might be tailored in different regions of the state.
Right?
So if things start happening in southeast Michigan again, that doesn't
mean the entire state will go back on lockdown.
Including UP.
I mean it will be a tailored sort of approach.
>> We also have a question moving up from state policy level to
national policy level.
Why are we doing so much worse than other countries in terms which the
Coronavirus the question asked what can we do to stopping worst of
world in emergency rooms it of infection and death rates?
>> You know, I knew that question would be coming.
It's its hard to answer.
I think there are a few reasons why we're doing worse than other
places.
I will also say, as a he normative statement we're doing worse than we
should be.
Part of it was a late, late response.
Part of that is somewhat understandable.
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Again, you know the way the virus played out in China and South Korea,
and Taiwan, and Vietnam, you know if you were following those
countries, as I was, Michael will remember I'm willing to admit that
even pack in January, even kind early February I was like, I don't
think it will be a bad a some people are saying.
Because I was very carefully watching other countries and seeing what
they were doing.
Well it didn't play out same way here obviously.
And again there were sort of a late start in many places to those
social distancing public hygiene emergency orders from Governors.
Was all right in a takes a couple week in communities it starts hitting
hospitals a little bit later than that.
So we were a little late to that.
But other issues I think are ones that become more political and are
less easy to sort of say, you know this was news, we didn't really
know, the U.S. so late to the game in test corner stones are social
distancing and hygiene measures, but testing and contact tracing of
people who are tested and found positive who they've exposed to are
essential.
And we were way, way, way behind on that.
And then, also I will state
>> We don't have national system of testing and tracing
>> No.
But we didn't even states that pretty good public health infrastructure
were behind game on that.
Because we really didn't know.
We didn't know it was coming we didn't know it would hit us like it
did.
We weren't prepared.
But you know, the public health infrastructure in this country has
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crumbled.
Has several decades it has multiple administrations public health
agencies are seriously under funded.
There's pandemic play books you know, we got plans for what to do, but
not resources at all to implement them.
And last thing I'll say has very disturbing to me is in United States
there's been a lot of I mentioned before you may not trust the numbers
from Vietnam.
They have 0 deaths do you believe that or not?
Up to you.
Do you trust the data coming out of Florida?
I wouldn't.
You know.
Epidemiologist in Florida a whistleblower got fired for saying I've
told to fudge the data on the number of cases.
Lots of we're seeing that lots of states.
Greatly disturbing to me because if we, if we can't tracking the data
we don't have confidence in the data, that, that is just bad for public
health.
>> It will undermine trust in government more broadly that essential
for getting us out of crisis
>> Exactly.
So we have quite number of other questions.
One you know, key question that people are think about just as they
walk around you know what happens if, you know you're wearing your mask
you're in an environment wear other people aren't wearing their masks
how do you what should you do?
Should there be law enforcement involved?
Should there be social other social controls?
What's the best strategy just generally for the kinds of social norms
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we need to stay safe?
>> Yes.
So there -- we, we need.
I don't think we need law enforcement for masks.
Because I am quite convinced without a doubt that won't enforced
equally across different members of our society.
>> We've seen that already.
>> We've seen that already.
No, that's not what we need.
We actually need better -- of all we need government leaders to
politicize the wearing of the mask.
Wearing a mask doesn't make you weak.
Wear ago mask doesn't make you, you know, buy into the left wing
conspiracy about this virus wearing mask doesn't mean you know, you're
whatever.
Wearing a mask is really important.
There's some modeling studies suggesting that if everyone would wear a
mask we actually might be okay not have peak where we all have to
hunker down again.
And create even more just havoc in and hardship in terms of what's
going on in economy.
So better public communication campaigns that really try to convince
people, not the T. Involves trust at all but are social marketing
techniques need to be used to find pockets of people what will resonate
how can you convince different groups of people.
Young invincibles, guys I'm actually because there's construction at my
house near my house today I'm in my office.
And walked on campus.
There are lot of lovely you know student looking like people walking an
are without masks.
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And not social distancing on sidewalks.
So what can campaign do they need?
What kind of campaign do we need for you know, other kinds of people?
But masks, masks are important.
It's no the only thing.
Right?
But if everyone wears a mask that transmission rate in community will
go down a little bit.
All of these different things layered on top of each other is what will
help keep that reproduction rate where we need it.
>> Paula that goes into another set of questions related to the
university's thinking about our strategy for next year.
The president of the university has said that he's hopeful that we'll
have a public health inform residential experience on campus,
universities making those decisions in the coming days and weeks.
How, what kinds of factors is the university considering?
I know that the school of public health advising the administration as
they did the Governor of Michigan on these matters.
How should we thinking about the kinds of steps that might improve the
public health outcomes for the university and inn that context?
>> Right.
Well we are going to have to keep thinking about these things for a
while.
Until there's a vaccine.
I bet you have questions about that.
I don't know.
I don't have crystal ball.
But we're not going to have a vaccine during next academic year.
We're really, really thinking about this.
We are unfortunately going have to keep 6 feet in every direction so 36
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square feet around all of us.
Away from each other.
We're going to have to think about density issues.
We can't we're not going to have giant gatherings.
There might be some students happy about this.
We're not going to serve pizza and shared pizza students sore sick of
us giving pizza anyway.
We will have figure out other kinds of food that more safe to give
people.
But you know we're going to have there will be some rules about masks,
hand washing, you know use of libraries and other kinds of facilities.
We, it is no the going to business as usual.
But I know Michael, what you the message you've giving people I want to
give people is that you know, there are reasons that we have to do all
of these things.
But as main thing driving us.
Is that we're so committed to our mission.
Which, at the Ford school we think is more important than ever right
now.
Our mission is you know, we're dedicated to public good.
And we have teaching mission.
We have a research mission.
We have a policy engagement mission.
And this is an election year.
And so we are trying to be as creative as we can about ways that we can
build our community, we have all kinds of new people coming into our
community to build it.
And have a thrive.
And figure out ways that we can communicate safely.
Some of it will through computers like this.
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Also we're going to think about the kinds of events and small group
interaction and mixing students up by their own volition as well you
know we're probably going randomly assign you guys to you know hang out
with each other and talk about issues.
We will still have guests coming in still learn from each other and
still try to have that exact on the world.
>>> I think that's an excellent point, Paula.
I mean we're all about trying to advance the public good as you said.
That involves teach our students it involves research and involves
policy engagement, making an impact.
And just as wee been doing these last few months we will need to
continue to be creative about how we go about our work.
Because, we can't the country can't afford for us to not be dedicated
to this mission.
>> Right.
>> So I think, you know I'm hopeful that university will come up with a
really interesting, exciting and effective range of strategies.
Obviously university as whole will be making a number of decision about
this.
Then the Ford school will be adapting those to our own were unique
circumstance where tight knit small community so many of our students
are actively engaged in the in the world will want to continue to be
doing that in a deep way.
>> Let me end you a question that I know many people are struggling
with that has come up in audience in feather different ways.
The question is, just how do we cope.
In particular the question says how do you recommend people stay
informed while managing the anxiety of all that this causes
>> Right.
How can we effective fight back against Coronavirus fatigue?
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We're all you know we're all just riffed a little bit we're all
struggling with this in different ways.
>> Right.
>> Those of us in leadership positions our students, faculty people in
the community, there's just so much going on layer on top of that the
increase folks rifle, folks protest on the legacies of racial injustice
in our society just really almost too much to bear for people.
How do you suggest that people are listening in navigating?
We want to stay them engaged.
You don't want to shut down, but it is a lot to be able to process and
take on.
So how are you navigating and how do you think about some of our guests
online might be navigating it?
>> Right.
I think everyone is struggling with this.
And how to best cope with the world right now.
Going to be very personal for people.
I think some things that cut across everyone or that sleep is
important.
So there's a rule at my house that I am not allowed to read the news
after 10 or 10:30 at night because I just am getting more angry and
upset say to my partner end now do you know what the numbers are.
You know.
So no.
Try to, try to shut down.
I know lot of people are turning to, you know mindfulness activities.
Just finding ways to -- I mean, it might sound like what luxury you can
spend time thinking about yourself.
But I mean it's really more physiological.
I mean right?
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A lot of your blood pressure might be up and you don't even know it.
Right?
Just trying to find ways to calm yourself physiologically.
So you feel then rested and able to do it the important work that you
all need to be doing right now.
Then so the other thing everyone find your passion.
And also, I'm motivated by anger a lot.
I mean a lot of things I'm angry about in world right now I want to try
to do something about it.
Figuring out you know prioritizing what do you care about your family,
your friends, your health is number one.
Right?
So what do you need to do to protect those things.
And then what are the things you're really passionate about in the
world that brought you to be interested in public policy that brought
you to be interested again in what's happening in the world.
Find ways to do those safely.
And then also, find, find things that bring you joy and passion for
fun.
You know.
If it's running it's some kind of outdoor activity that we can finally
do in Michigan again.
If it's cooking.
If it's knitting zoom chats with your friends.
Make time.
It's cog that an everybody feel frustrated lethargic scared, sad.
It world we're living in we have to admit it and pick ourselves up.
But if you really are struggling find those peoples that will help you
get resources that you need to get mental health your mental health and
physical health in shape for important work you want to be doing in the
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world.
>> Well Paula I think that's a great note to end on.
Inspiration a call to action.
A call to rejuvenation.
Because it is so hard right now being able to have a mission and to
work on that mission and to take care of yourself I think is so, so
critical. I want to thank you for walking us through this important
issue this afternoon.
I'm sure everybody has learned a lot.
And thought about new ways they might get engaged.
And, I really appreciate your time this afternoon.
I know you're super busy.
So thank you for joining us
>> It was an honor
>> Thank you for all of you that joined us online.
We had lot of people joining us on zoom and social media.
Hopefully all tune in for another Ford school policy talks later this
summer.
We will continue our series and look forward to seeing many of you
again.
In the meanwhile, let me just say, thanks for joining and of course, go
blue.
>> Thank you.
And then a some of incoming students I'm going chatting with, again in
a little bit this afternoon.
So, those of you new to Ford community in fall I looked forward to
chatting with you a little bit more later today.
Thank you.
>> Take care.