91 Comments

I have struggled with listening to the recaps, from 2020. It still triggers such anxiety. I don’t even consider myself to have been much more than “present”, rather than front line, when seeing patients in the office setting, but I suppose it was, essentially. I could only mask, gown, change scrubs before going home, etc., and you know, it absolutely helped. I do recall during April 2020 shutdown needing to see someone in person who did not mention until sitting across from me, in their fabric mask, that they actually had a positive covid test in the hospital the day prior and was told it was a false positive. Whether we were at risk, or it was our children, spouses or elderly parents that we cared for, the fear was real. Really real.

I received, quite gratefully, a vaccine in 12/2020. Leap of faith, but after three months of lectures and education on all the vaccines from so many that I trusted- Dr Schaffner, Dr Hotez, Dr Offit, I trusted in all the data and wonderful thoughtful analysis. It was a game changer for us in medicine particularly, if not for so many.

I love both you and Ezra Klein. I will eagerly listen. But perhaps with a glass of wine in hand later this evening... it’s still raw for me thinking back on that time of the pandemic.

Expand full comment

It really bugs me that people are so down on closing schools. I recall that, at that time, we hardly knew anything. Except that in previous pandemics, the old people and the young people were the usual victims. How could we know that kids would be okay! Just saying.

Expand full comment
Aug 31, 2023·edited Aug 31, 2023

The problem wasn't closing schools, it was keeping schools closed for so long, a year or more in California, even though there was ample evidence that covid posed little risk to kids, that kids with covid weren't a huge risk to the rest of society, and that there was zero hope of "containment."

Examples of successful early reopenings were abundant: charter schools, Catholic schools, other states, other countries (Germany).

Expand full comment

I totally hear you. But what about the teachers? Many are old, were just meant to just forget this? Many people take immunosuppressive drugs now due to advancement in therapies for many disorders.

I saw places open and then close (wasn’t this just in a mid Atlantic state just this month) due to so many teachers getting sick there was not enough staff to manage the students?

This was so complicated and unprecedented. Mistakes or overcompensating was bound to occur, as well as under compensating.

I really get that there were settings that were slow to adjust. And that is where learning and experience will hopefully help the next one... and there will be a next one.

Expand full comment

Other places figured it out without unduly harming teachers. I dunno: open the windows? Better ventilation? Outside classrooms? Hybrid learning?

We also need to factor in the enormous costs to students in terms of lost learning, absenteeism, diminished ability to attend college and earn future income, child abuse, anxiety, depression, overdoses, suicide. Not surprisingly, the poorer students fell behind the most.

No nation should sacrifice its children to protect others. Children are our future.

Expand full comment

I think maybe part of the problem was that in many ways the school closures were a concession to what was happening anyway. There's been a considerable amount of labor unrest over the past few years (culminating in two major Hollywood strikes at the same time!) and I'm not sure how much of a choice there was on school closures. Had we not closed schools, teachers would likely have retired en masse (many did anyway). At my work place - not education, but a union shop with great benefits - prior to lockdowns a lot of us simply dropped "vacation bombs" on our employer. I really think the tail wagged the dog in a lot of workplaces. Reopening sounds great, but nobody wants to bell the cat.

Expand full comment

"I saw places open and then close (wasn’t this just in a mid Atlantic state just this month) due to so many teachers getting sick there was not enough staff to manage the students?'

This is not unique to Covid. When too many students or staff get sick, it was practice to close school briefly [1]. What was unique to Covid was extended pre-emptive closures which had no scientific basis (to falsify my claim, show me pre-2020 pandemic planning recommending extended closure of schools "just in case").

This was largely a US construct, as nearly every country in the world returned to school for the 2020-2021 school year without incident.

________________

[1] For example, all pre-2020 stories:

School closed after 200 students report illness

https://www.fox19.com/story/19976864/batavia-elementary-closed-friday-due-to-stomach-illness/

Widespread illness shuts down Denver elementary school

https://www.9news.com/article/news/denver-sickness/73-f081a7c8-1ae1-434f-bf91-e955ff9ca33d

Schools Are Closing Amid Flu Outbreaks

https://www.usnews.com/news/national-news/articles/2019-02-07/schools-close-hospitals-restrict-visitors-amid-flu-outbreaks

Corbin schools closed Friday for widespread illness

https://www.wymt.com/content/news/Corbin-schools-closed-Friday-for-widespread-illness-411375055.html

Expand full comment

I think people forget the last part. Remote learning was horrible, but I think the 6 months - 1 year after return was even worse and more chaotic because you never knew day to day whether schools were going to be open. So many times schools had to close because too many staff members had COVID. Several times they put all our students in the gym, sitting on their computers because they didn't know until last minute that they didn't have enough staff. Some parents may have needed to send their kids to school, but many people would have kept their kids at home since they were basically doing remote learning in the gym. (Or actually worse than remote learning because there was often no teacher guiding them, just computer programs to work on.)

Expand full comment
Comment removed
Expand full comment
Aug 31, 2023·edited Aug 31, 2023

Quarantine and isolation rules also contributed to the numbers and lengths of student and staff absences. My child's elementary school was only built a few years ago. It has a modern HVAC system. My county spent money on upgrading HVAC in all schools, and added standalone units to classrooms it deemed needed them. We prioritized teachers being eligible for the first vaccines. We had mask mandates. We still had children entirely out of classrooms for a full year: March 2020-April 2021. And April 2021-June 2021 was optional return to school on a hybrid basis. I am very grateful that when the initial Omicron spike happened (over Winter Break, mind you, when kids weren't in school so weren't the cause of it) that the Board of Ed did not listen to the voices advocating for an across-the-board return to virtual for all of January and February but instead dealt with outbreaks on a case-by-case basis, as they would have if a large number of people in a given school/grade/class were contracting flu or chicken pox or anything else and where the standard is return if feeling better or after 24-hours fever-free.

Expand full comment

You're lucky you don't have long covid or a child that died as a result. I know people who had both.

Expand full comment

"Examples of successful early reopenings were abundant:".....

Its about CHILDREN, the most precious thing in our psyche. For many, that is not necessarily a place wherein rational thought lives, even among the highly educated. Add to that the opportunistic political messaging, and the result is what we got.

Expand full comment
Comment removed
Expand full comment

Speaking of political shills......with excellent vocabulary and pseudo-academic terminology....

Expand full comment

Two important points:

1) We already saw by summer of 2020 that the countries which reopened schools Spring 2020 did just fine (Norway, Finland, Denmark, Sweden). We would continue to see through Fall 2020 that the schools which went ahead and opened in other countries did just fine. We would see around us in the US that the private schools which opened also did just fine.

2) Not since modern medicine (~1940s) has there ever been a flu pandemic that killed any more children than baseline deaths - and that includes Hong Kong Flu, Asian Flu, SARS03, Swine Flu, MERS, etc.

Therefore, the premise "young people were victims" was no longer true after ~1940, and this was still true during Covid as there were no excess deaths in children once you subtract out the excess accidental deaths (homicide, suicide, overdose, drowning, car accidents).

Expand full comment
RemovedAug 31, 2023·edited Aug 31, 2023
Comment removed
Expand full comment
Aug 31, 2023·edited Sep 2, 2023

In the first 3 months of exposure (even first 3 years), one doesn’t begin to know the full harmful (or beneficial) effects of any chemical, infectious, or immunogenic agent on any complex organism, particularly one with a decades-long lifespan. Some effects take decades to show, or a million cases to occur, prior to a statistically compelling documentation of effects being assembled - even IF one were looking, instead of a priori denying. Some ill effects are only apparent in the offspring a generation later - again, if one looks.

Please preserve your scientific appreciation of the complex, the unknown, and the ‘slow but big’ dynamics already known to occur in nature.

Did we know about radiation poisoning in the first three months of the discovery of x-rays? Thalidomide effects in the first decade? Flu virus, herbicides, and Parkinson’s disease until a generation later? Zika, Epstein-barr virus and flu, etc with Guillian-barre paralysis? Flu viruses & aspirin with Reyes Syndrome? SARS coronavirus 2 infection and subsequent IQ diminution in the most frequently infected voters? doi: 10.1126/science.adk6149

No, some ill effects take time, a very large number of cases, and a willingness even to look - before the facts of the effects are realized.

Darwin Award of the decade goes to those Republicans who refused to mask during Covid, just to ‘own’ the democrats.

Given the millions of refusnik cases, the differential partisan die-off has already been estimared to deliver a key 1-2% to those ‘damned dems’.

Karma’s a thing.

Expand full comment

Awesome! Best rant I've read this month.

Expand full comment
founding

we've all heard enough from you. disappear, troll

Expand full comment

I am a great fan of the Ezra Klein show and of scientists who educate the public about Covid. But I was terribly disappointed with the acceptance of the premise at the start of the interview that Covid is over, based solely on death rates. It seems to me a more truthful answer is that we don’t know, perhaps the hypermutated BA 2.86 becomes highly transmissible. I was also very unhappy that long Covid was completely overlooked. If these important issues are not incorporated into every discussion regarding Covid, it supports behaviors of people that will spread Covid.

Expand full comment

David, excellent points.

Expand full comment

You were great! Answered the questions in a forthright manner and very humbly acknowledged the unknowns. Your recognition that science is about evolving knowledge is essential for those who want to relitigate the issue of school closings . Well done.

Expand full comment
Aug 31, 2023·edited Aug 31, 2023

You did a masterful job of staying apolitical, even when asked essentially, "How many deaths could have been avoided?" To me that answer is quite clear -- with a thoughtful initial response by the administration, things would have been wildly different. Instead, the infected cruise ship was not permitted to dock for fear that the numbers would make trump look bad, we were told that there were 15 cases that would soon be zero, that it was a Chinese problem and that the Chinese had it fully under control, then we heard that we would all be back in church celebrating Easter in April 2020. The brilliant Jared Kushner next observed that blue states were being disporportionately hit and dubbed it a democratic disease, which ultimately morphed into a democratic hoax. Then we were forced fed Hydroxychloroquine, and led to believe that Medal of Honor recipient Anthony Fauci could not be trusted. Who could forget the look on Birx's face when she first heard about UV light and internal disinfectant? When you mention pandemic revisionism, all of these things, and their negative effects must never be forgotten.

Expand full comment
Aug 31, 2023·edited Aug 31, 2023

Medal Of Freedom, my apologies....

Expand full comment

THAT IS THE BEST-EVER RANT.

With awe and respect -

Heinz

Expand full comment

Thank you Heinz! 😉

Expand full comment

I voted for Biden, but most of the 1.1 million deaths happened under his administration.

Expand full comment
founding

It’s definitely political not to mention such things. As it is to claim to be unpolitical.

Expand full comment

I notice that you suggested weighing a couple NPIs, "we still do not know what works best to slow the spread of Covid-19 in terms of non-pharmaceutical interventions. For example, test and trace, or isolation, or quarantine, or indoor mask mandates, or closing venues." Is it simply unhelpful obsession of mine to think that you had a platform with DDW/EK and did not push ventilation much. You said, "So just getting that one dose is just not enough. Just not wearing a mask or not thinking about ventilation or not testing, just having a vaccine strategy is going to let the virus leak through for a certain amount of population." Indoor Air Quality and therefore ventilation seems primary and foundational and to be stressed much more than the psychologizing about how to me since it does not require convincing and coercing. Do you see that as misguided? I realize that DDW pushed you toward evaluating "human response" and toward psychologizing rather than toward public health analyzing. It's always interesting to hear your point of view, epidemiologicak, motherly, or human.

Expand full comment

It's cost, I think. The amount of money that's required to upgrade physical infrastructur is considerable - to the point where any business that wants to do that would either have to raid their reserves (if they have enough available not already earmarked for other essential functions) or take out loans. Passive ventilation is an option, but that creates tradeoffs with comfort and energy use.

Expand full comment
founding

It’s not an obsession—it’s telling that even Jetelina can overlook it.

Expand full comment
Aug 31, 2023·edited Aug 31, 2023

I look forward to listening to the podcast on my morning walk.

It's disappointing that, as a country, we cannot come together and understand "lessons learned" so we can do things better moving forward.

As far as "vaccine mandates" go, our country doesn't suffer from "revisionist thinking," it suffers from "DENIALIST thinking" - as in, vaccine mandates NEVER HAPPENED, nobody lost their job, nobody lost their paycheck, no student was prohibited from attending school, the CDC never said vaccines would stop infections and transmissions, no tennis star named Djokovic was denied entry in to the country so he could play in the US Open despite 2 cases of documented covid and natural immunity, etc - NONE OF THIS EVER HAPPENED.

Expand full comment

Great interview. Thank you for mentioning the importance of communication, and how this could be better when it comes to warning certain at-risk groups, especially after vaccines were rolled out.

If CDC had been brutally honest and told us "people who are 70+ years old, obese and/or immunocompromised have a 1,000 times risk of dying from covid and therefore need to continue mitigation measures even after vaccination" (made up example to illustrate a point), a large portion of the 1.1 million deaths could have been prevented.

Instead, CDC issued a list with dozens of comorbidities that included nearly every adult, sorted alphabetically - not by risk - making the list virtually meaningless. Certain people were unaware just how deadly covid was at an individual level because, for what ever reason, nobody had the courage to communicate the truth.

Expand full comment

Agreed. I'd also like to have seen a "risk score" taking various factors into account - age, BMI, antibody count, sex.

Expand full comment

It's not that we can't, it's that some people refuse because politics and capitalism.

Expand full comment

It's a terrific show, Katelyn! And it's a model of the honest reflections all of us should be doing. thank you.

John

Expand full comment

Congratulations!!!

Can’t wait to listen.

It’s a different gear to speak off the cuff, I find writing a much better intellectual speed personally. I’m sure you did great 😊

Expand full comment

Your recent Substack about living with COVID is so good: as another family doctor, you are also a great communicator.

Expand full comment

Thanks Jan :) we family docs have to stick together! 👍

Expand full comment

Thank you! I listened to you on the NYT site, great job. I heard on the In the Bubble Andy Slavitt podcast that you will be on that podcast soon! Looking forward to it.

Expand full comment

So wonderful to see your smiling face as well as listen to your experiences and reactions to the past 3.5 years of loss and medical uncertainties. ❤️❤️❤️❤️

Expand full comment

He’s a fantastic interviewer and I look forward to listening…and learning.

Expand full comment

I happened to read the interview transcript yesterday & give you BIG points for being able to wade thru DWW's overly-wordy, wandering questions! I avoid all his pieces/writing as he's not a clear writer/thinker (am sure mine is a minority opinion...but I used to be a writer/columnist also). So I can see why this was your most challenging interview! I noticed you most always agreed with him, but you gave much more succinct answers. Also, what Ryan McCormick said below about speaking off the cuff being much more difficult than writing is true....no time to think! Thanks for doing the interview!

Expand full comment

They were more like auditory Rorschach tests than questions

Expand full comment

Great show Katelyn! I’ve been following you since early on in the pandemic. Your responses to the questions in this interview were great. People want simple answers, but in a complicated world, the answers are rarely simple. You do a great job, both in this interview and on Substack, of breaking down the inevitable nuance into bite-sized, fact-based, chunks that most people can digest. Science communication at its best! Keep it up Katelyn! Thank you so much!

Expand full comment

Thank you so much! I look forward to listening to this. Processing all of this trauma, loss, and complexity is very hard and very necessary. And I so admire you for doing it in the face of finding it scary. Always a sign of a good leader.

Expand full comment
founding

Yes, it is very disappointing to see so many voices who are generally respected and listened to endorsing, even implicitly the false and dangerous claims that the pandemic is finished.

Expand full comment

Thanks for doing that interview, Dr. J! New Yorker married to a Texan here, and Texas gave you the gift of how to listen?? Well dust mah boots off! That, and several other of your “but look at it this way”s really helped me see more nuance. This is only going to help when the next pandemic occurs. Thanks a million ‘til you’re better paid, as my German grandfather used to say ;)

Expand full comment