Playlist: Featured

Paula Lantz - COVID-19: From Epidemiology to Equity

June 17, 2020 1:08:10
Kaltura Video

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.



>> 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


I'm looking forward to talking with her today about such an important


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



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 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


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


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


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.


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


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


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


>> Right.


>> Then the rate will go down.

>> Exactly.


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


They take to their beds they stay home they are not out in the


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.


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.


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


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.


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


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.


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.


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


So stay at home orders.

Closing schools.


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.


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.


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


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.


If I could have next slide as well up there.

There is so that would slide number 4.


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.


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.


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


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.


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.


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


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


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.


You know it's hard to wash your hands if your water has been shut off,


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


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


Let me read the numbers to you.


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 --


>> 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


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.


>> 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 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.


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


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


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,


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


inequities in general forever.

It's not, it's not easy.


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


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


>> 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


So, there, and then healthcare, I think everyone knows it's a mess.



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


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.


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


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


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


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


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.


>> 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


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


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.


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


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.


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


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


We weren't prepared.

But you know, the public health infrastructure in this country has



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


>> 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


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


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.


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.


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


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


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


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


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.


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


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?


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


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?


A lot of your blood pressure might be up and you don't even know it.


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.


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


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



>> 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


We will continue our series and look forward to seeing many of you


In the meanwhile, let me just say, thanks for joining and of course, go


>> 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.