‘ A KIND OF SADNESS’
Yale’s Ko sees heroism, missteps in state’s reopening
NEW HAVEN — For Dr. Albert Ko, an epidemiologist at the Yale School of Public Health and a lead adviser to Gov. Ned Lamont on COVID- 19, the pandemic has offered lessons the nation would do well to learn.
Structural problems in American society, including a lack of support for public health, including the ability to track emerging diseases, and major inequities in health care that harm people of color, predated the coronavirus and helped to plunge the nation into a year with 500,000 deaths, he believes.
“It’s almost a kind of a sadness — it’s very hard to escape — about what this pandemic has told us in the big picture,” Ko said.
One good thing that could come out of the pandemic would be finally addressing those endemic problems, he said.
Ko, who led the Reopen Connecticut Committee last spring with Pepsico CEO Indra Nooyi, put together a plan with Gov. Ned Lamont and his team that spared Connecticut much of the suffering of other states and the confusion experienced in rolling out vaccines.
“[ Nooyi] ran it tightly and she made sure that all the attention to detail was done. That plan was really to her credit,” Ko said. “We did it carefully and she really, in her executive skills, was really key.”
While the U. S. has not handled the pandemic as well as others, such as South Korea and New Zealand, the experience hasn’t been all negative, Ko said. “There are a lot of success stories like the vaccines. … A vaccine in one year, it’s just tremendous,” he said. There also have been “success stories, the really heroic efforts” of health care workers. “We saw how countries like Italy in the first surge got overrun, completely overrun — 20, 30, 40 percent of health care workers getting infected,” he said.
Erosion in public health infrastructure
Ko said the pandemic showed “the disproportionate impact that this has had on the United States compared to other countries. … This really showed us decades of neglect in investment in public health.”
While the Centers for Disease Control and Prevention is “kind of the pride of the country,” Ko said, “there’s been an erosion. That didn’t happen just in the last administration. And there’s certainly factors within that administration that eroded the strength of our public health decision- making processes, but that erosion happened over decades.”
Ko also believes the U. S. has fallen behind in its use of scientific data and evidence in addressing public health issues. “We see other countries have now become kind of the paradigms, thinking about countries in Asia, about really not only the flexibility but the speed and the rapidness of using data to inform decisions,” he said.
Another longstanding issue is the inequity in health care, “the disproportionate impacts on communities of people of color,” Ko said.
“It’s not like that happened overnight, either. We have to ask ourselves why,” he said. “This is a disease that affects the elderly, that affects people with underlying medical conditions, and how can we allow ourselves to have large swaths of underserved communities and the people living in underserved communities with really poor states of health that place them at risk.” COVID is merely a symptom of a deeper problem, he said.
Ko believes we will not be able to eradicate COVID- 19, largely because it is so highly contagious. “There’s some similarities, but there are also important differences between influenza and the coronavirus,” he said. “The first thing is that this disease is much more transmissible. A good example of that is that we have almost no influenza, right?” That’s been attributed to measures such as wearing masks and social distancing.
“And yet we’re having a lot of COVID. That tells you how difficult, how this is different from influenza,” he said. “Because of that transmissibility … my gut feeling is that we will never eradicate this disease. The best we can do is to control it.”
Another reason the disease will continue on is the resistance by some to take those steps to protect both themselves and others. “That’s going to take buy- in, citizenship, people thinking about others, just not themselves,” said Ko, who has long experience working in the poor cities of Brazil.
“We just did a survey of people in the poorest slums, urban communities in the city that I worked in. Eighty percent of people want to take the vaccine,” he said. “And the biggest motivating factor is because they want to protect their family and they want to protect their community. And that’s what we need to create, that kind of citizenship.”
What the state got right
Ko said he thought Connecticut, for the most part, had made the right decisions when it came to reopening after the shutdown in March.
“It’s easy, especially for us in academics, it’s easy to sit back and criticize and be the armchair epidemiologist,” he said. “There’s an obvious need to make decisions, based on evidence, and sciencedriven, and those have been almost kind of like cliches now. But in reality, decisions are made on judgment because we have lack of evidence. … In reopening the state, I think we got it right. We had low levels throughout the summer and going into the fall.”
Keeping bars closed and schools open were two important decisions that some states went the opposite way on, he said. “I think we have to be completely humble in what we know and what we don’t know, and we still don’t know exactly what the risk is in people going to school,” Ko said. “But based on where we’re at now, I think the state got it completely right in doing everything it can to keep the schools open. One, because of this issue of disproportionate impacts, the people who depend on schools and don’t have access to the learning.”
Ko also defended Lamont’s decision to open up vaccinations largely by age, in order to get people immunized in as efficient a way as possible. “In a mass vaccination campaign, or anymass public health prevention, we need to do it simply,” he said. “The more complicated … you make a lot of problems along the way. And I was always concerned about the CDC recommendations that came out.”
While some younger people with health issues will be behind healthy 50- year- olds, Ko said “it’s a question of speed and efficiency versus precision.”
“Generally, age is what we call a marker or proxy of health status,” he said. “So, certainly, there are going to be those people, but … that’s the balance between … getting it out quickly and … targeting it to people with the highest risk. There has to be a balance between those two and especially in a mass- vaccination program.”
Ko said Connecticut has done a good job of protecting nursing home residents, at least in the second wave.
“I remember I was at Yale New Haven Hospital. The first case was diagnosed March 13,” he said. “And it just spread like wildfire in not just Connecticut, but New Jersey, New York, Massachusetts. … And there’s not enough time to react. Lesson learned. Second wave, they got the testing in. There are still outbreaks in nursing homes, but much less than what we observed in the first wave.”
The speed with which the pandemic hit had everyone scrambling without the proper tools, Ko said. “We’ve got to take ourselves back. At that time, we didn’t have a diagnostic test. Remember that the CDC had dropped the ball on that. We were completely unprepared ( in) the hospitals. … Marie Landry [ director of the Yale School of Medicine’s Clinical Virology Laboratory] was the first one to come up with a clear, FDA- approved test outside of what the state was using.
“It had already spread throughout the nursing homes,” Ko said. “We didn’t have a test. We didn’t know who was infected, who wasn’t infected, who needed to get quarantined, who needed to get isolated. … We’re telling people not to come into the hospital unless you’re sick because we didn’t have any tests out there. So kind of bring ourselves back to that mindset. … Not to be kind or generous to the state, but it was a horrible situation. We were completely unprepared for it.”