Preventing the Spread of Infectious Diseases with John Brownstein [Episode #477]

This week’s topic is: Preventing the Spread of Infectious Diseases with John Brownstein

I am so excited to have a very special guest, John Brownstein, who is a trained epidemiologist, Professor of Biomedical Informatics at Harvard Medical School and is the Chief Innovation Officer of Boston Children’s Hospital. Listen in as John shares his expertise when it comes to disease and the latest COVID-19 outbreak, the underlying conditions that could lead to death and ways we can take action to prevent the spread of any epidemic.

[BULLETS]

• John’s journey studying disease and becoming an epidemiologist…
• Susceptibility and underlying conditions that could lead to death with COVID-19…
• Precautions to take to help prevent infection…
• If the virus can linger on surfaces and how to keep some balance in our lives…
• We discuss when things will open back up and the possibility of a resurgence…
• COVID-19 and your immunity…
• Underlying risk factors for COVID-19 and immediate steps to take for the greater good…
• John shares the idea around his website, COVIDNearYou, and how you can be supportive…
• Trials for vaccines and potential side effects…
• Children and COVID-19…

[FEATURED GUESTS]

About John Brownstein

John Brownstein, PhD is Professor of Biomedical Informatics at Harvard Medical School and is the Chief Innovation Officer of Boston Children’s Hospital. He directs the Computational Epidemiology Lab and the Innovation and Digital Health Accelerator both at Boston Children’s.

He was trained as an epidemiologist at Yale University. Dr. Brownstein is also Uber’s healthcare advisor and co-founder of digital health companies Epidemico and Circulation.

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John’s Interview

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Transcript:

Note: The following is the output of transcribing from an audio recording. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate. This is due to inaudible passages or transcription errors. It is posted as an aid, but should not be treated as an authoritative record.

Quick announcement for you, Beauties. As you know, I’m about to have my baby and I will be going on maternity leave starting next week. Don’t worry, though. I have prerecorded some amazing shows for you to enjoy while I’m spending time with my new beautiful baby boy and adjusting Bubby to having a sibling, and of course, hubby. In Ayurveda, there is a sacred 40 days of rest that the mother would ideally take post-birth to bond with their child and to help rejuvenate her body. So I definitely didn’t do that with Bubby. I was back to work right away, but I’m really committed with this baby to observing this really sacred time with the family. And I look forward to being back with you in the upcoming months.

Again, we’ve got so much material. We’ve gotten ahead with the show. So we are not going to miss a beat. We’ll have lots and lots of great stuff for you on here. And I’m always with you. I will be actively on Instagram. You can still reach out. I’m going to be talking to Katelyn regularly. You can still submit questions and everything will go forward. But I just want to wish you so much love and gratitude for you being part of our community. I am so, again, just grateful for our connection and that we can be on here together. Namaste Beauties. Lots of love and see you back here soon.

Kimberly: 00:12 Hey Beauties, welcome back to our Monday interview podcast. I am super excited for our guest today. His name is John Brownstein, and he is a trained epidemiologist, Professor of Biomedical Informatics at Harvard Medical School, and the Chief Innovation Officer of Boston Children’s Hospital. Very impressive resume. I cannot wait to pick your brain today, John, about all things that are going on in the world today.

Fan Of The Week

Kimberly: 00:40 Before we jump in, I want to give a quick shout out to our fan of the week. His or her name is rockyu9, and he or she writes, “Love the guests that come on the show. I always feel lifted and awakened after listening.” Well, rockyu9, thank you so much for being our fan of the week. I’m so grateful for your review and for us being connected. Sending you a big virtual hug, wherever you are

Share The Podcast & Write A Review on Itunes

Kimberly: 00:48 And Beauties, for your chance to also get shouted out as the fan of the week, please just take a moment or two to leave us a review on iTunes, which is free and easy, and a great way to support the show. Also, please make sure to subscribe. That way you don’t miss out on any of these Monday interview podcasts, and our Thursday Q&A podcasts with questions that come right from the community.

Interview with John Brownstein

Kimberly: 01:28 All right. All that being said, John, thank you so much for coming on with us today. I know that you have probably been very busy, very tapped for information about everything that’s going on with COVID.

John: 01:41 Yeah, it’s been a wild ride for the last few months, really. My background is infectious disease epidemiology, so this is something you get trained on, prepare for for a lot of years. Yeah, it’s quite a crazy time right now.

Kimberly: 01:56 I think I heard that you recently briefed Congress on COVID?

John: 02:01 Yeah. That happened, I guess now it’s been over a month, maybe almost two months ago. This was right at the beginning starting point when we were trying to sound the alarm on this new virus. This was before WHO was calling it a pandemic. This was before really the White House was taking things seriously about what was unfolding. This was about trying to say we need better tools. We need better technology. We need better response, because clearly where we are today, unfortunately probably could have been prevented. We still have a lot to do to prevent the deaths that keep popping up right now, unfortunately.

John’s journey studying disease and becoming an epidemiologist

Kimberly: 02:45 So John, how did you get interested in disease, studying disease, being an epidemiologist? It’s a very interesting field to go into.

John: 02:57 Yeah, it’s kind of niche. When I was younger, I was planning to go to med school, and definitely was interested in clinical care. I was also very interested in math, and statistics, and computer science, and geography. I took a semester to spend in Kenya and Uganda, and learned a lot about the connection between environment and disease. Climate has a direct impact on disease. Animal populations, like we’ve seen with Coronavirus, have a direct impact on disease. Interplay between all these external factors and risk to humans is actually pretty significant.

John: 03:38 Then I realized that as much as I was interested in medicine, there was a field called epidemiology, which could [inaudible 00:03:46] a lot of the different diverse sets of interests. [inaudible 00:03:52] these as opposed to feeling one-on-one with patients. Public health is such an important tool, because the things that you can identify in how you work in public health, you can actually impact the lives of millions at the same time if you [inaudible 00:04:06] study, whether it’s nutrition, or exercise, or prevention in vaccines. These are all public health tools that can save millions of lives, so at that scale, you can have real impact in life.

If the spread of COVID-19 could have been prevented if we were quarantining earlier

Kimberly: 04:21 Well, I’m interested in getting into a little bit about the animal connection in a moment. I’ve been plant based, John, now for over a decade, and we talk about here a lot of the environmental impact of being more plant based. You say that all or nothing, but my Ayurvedic doctor recently came on and talked about his perspective in India where there’s a lot of vegetarians, why the spread may be less. Anyways, that’s a whole other topic I want to get into and pick your brain on, but that’s really interesting to hear about your background. In many ways, you’ve been one of the people most prepared to go to for information on something like this, which has never happened in our lifetime. You mentioned earlier you think this could have been prevented. In what way? Do you think if we were quarantining earlier, then there wouldn’t be so much widespread …

John: 05:19 Well, there’s different stages. During the earliest stages, this virus came out of animal populations, likely from bats. We know that there’s all these viruses cycling in animal populations, and there’s a lot of work … In fact, I was part of a team that was spending a lot of time thinking about viruses as they move from animals into humans. Actually, that funding was halted by the federal government last summer, so it was funny timing to stop that kind of research, but clearly, with better surveillance in animal populations, better surveillance in human populations, that could have potentially been stopped at the source.

Kimberly: 05:59 Oh.

John: 05:59 That’s one option. The other is, of course, as the cases were building up in China, we did things like halt travel, but we should have been really thinking about the fact that it was going to be unlikely to prevent introductions of cases coming into the US. At that point, we should have had better testing. We should have been isolating cases. We should have been contact tracing. We missed the boat. A lot more cases came in in February, likely January. All of a sudden then, we’re like, “Shoot, we can’t identify every case and isolate them. Now we have to go to social distancing,” which is what we’re doing today.

John: 06:35 Unfortunately there, we were pretty slow at that, so at every step we should have done something a little bit faster. We should’ve been more prepared, and we got caught a little flatfooted. So yes, now communities across the country have done it, and some communities have done a much better job than others, clearly. California, where you are, has been great in terms of responding quickly, helping doing this thing called flatten the curve, using [crosstalk 00:07:02] cases. I think that’s a great example of it done well. I think there’s other places that were slow, that were succumbing to a lot of public pressure. We’re seeing this in Michigan right now, Georgia is opening up.

Kimberly: 07:16 Yes. What do you think about that?

John: 07:19 Yeah. Well, the data doesn’t suggest that’s a good idea for cases that are mounting. They haven’t reduced the curve at all. It’s still at peak, if not quite at peak. You start loosening things up, people are mixing, spreading infection, and then all of a sudden, now we’re going to have new cases and clearly more deaths.

Being quarantined for vs reducing the number of cases

Kimberly: 07:39 What do you think, John, about some people say I’ve heard … There’s so much information. It’s so confusing. There’s all these videos going around, but I heard one doctor saying, “This is unprecedented in quarantining the healthy.” Usually we quarantine the sick, and of course we know a lot of people are asymptomatic. A lot of people are really pushing back because of the economic toll, all these small businesses. It’s such a crazy issue. You don’t want to play with people’s lives, but if you were in charge of all the policy, how long would you want people quarantined for?

John: 08:16 Well, it’s not about an amount of time; it’s about reducing the numbers of cases to the point where we can do things like identify a new case, trace contacts, isolate people, and do things at the individual level. But the only way you can do that is with having cases at a low enough level that that can happen. Yes, it’s super painful, and things could have been done sooner, but the reality is it’s [inaudible 00:08:43] the vulnerable, it doesn’t work, because ultimately it still results in a lot of deaths. In this country, there is underlying chronic conditions at levels not seen anywhere else: obesity, heart disease, diabetes. These are all risk factors for COVID. You’d be in a situation where you’d have to quarantine, again, the entire population of the US, or close to it, given the underlying conditions that we experience.

John: 09:17 Unfortunately, the US has a very vulnerable population. That’s why we’re seeing so many deaths compared to other countries, unfortunately. But the reality is if we can just hang on a little bit to get the cases down, then we can start to really begin to contain things. If you have communities reopening too fast, then you just start the clock in ways over again, around that. Yes, I clearly see the stress that it causes, but we’re trying to avoid having a prolonged effort, and this is what this reopening might do.

Susceptibility and underlying conditions that could lead to death

Kimberly: 09:50 Right. John, you talked a lot about underlying conditions. In a way, in the beginning it was like, oh, the elderly are really susceptible. Protect our parents, our elderly, our grandparents, but then the scariest thing to me is when you hear cases of people that are, oh, this person was completely healthy. They’re in their 30s, and they don’t have any underlying conditions. Is that true, or do these people, do you think, have some sort of susceptibility, underlying conditions maybe they’re not aware of? How could someone randomly, supposedly young and healthy, perish from this?

John: 10:27 Well, there are two things to say about that. There are deaths that we have from things like flu, from apparently healthy people. People might just get an increased viral load, and just be unlucky in that sense, but also what we count as underlying conditions is highly variable. We’re not considering necessarily obesity as an underlying chronic condition, but it is. You have to adjust for the fact that there are underlying illnesses that may not be the traditional ones that we’re looking at for chronic disease patients, but they’re still ones that are major risk factors.

Precautions to take to help prevent infection

Kimberly: 11:01 I see, I see. It’s easy to go down with this panic with hand sanitizer, and people hoarding toilet paper. What’s the real science here? Do you think if you wear a mask … I still have to go to the OB/GYN. We’re super pregnant, and everybody in there is wearing a mask. If you wear a mask and you wash your hands, is that good enough protection, or is there other things we should be doing?

John: 11:27 Yeah. Listen, I think at the end of the day, the majority of us are going to handle the infection fine. It doesn’t look like there’s increased risk for pregnancies, for children, which is great. That does put you in a high risk category, so doing things like hygiene, hand washing, trying to maintain social distancing, masks … Masks are good to prevent you from spreading infection to others. There’s potentially some protection from others back to you as well. It’s good practice, because you may be asymptomatic or pre-symptomatic. You want to wear a mask.

John: 12:09 Those are the main activities that people should be doing. It’s a lot to ask to go too extreme. At the end of the day, since our objective is really just trying to keep the health systems from being overwhelmed, it’s really just about reducing transmission. It’s not because necessarily you’re going to get super sick and die, but it’s because you’re trying to limit the risk to the broader population. What you can do is what you can do at the end of the day. We don’t want to create this paranoia on the part of the population that goes to extremes. I think that would do a disservice, and there’s all sorts of impact on the mental health front and others. We’ve got to find some balance here.

If the virus can linger on surfaces and how to keep some balance in our lives

Kimberly: 12:49 Right. What about surfaces, John? When this first came out, I was freaked out to handle Amazon packages. [inaudible 00:12:56] shopping with gloves. Can this be transmitted through groceries?

John: 13:00 There’s definitely some evidence the virus can linger on surfaces. Now you need to have enough virus on a surface to cause an infection. Even if it survives, that doesn’t mean it can cause an infection. There’s limited data to support that. I think the reality is we can do what we can on that front in terms of trying to keep our homes clean, surfaces clean. Packages that come in from Amazon, likely the virus will have died by the time it reaches you anyways, so the risk is very minimal. At the end of the day, we’re just trying to make calculated risks, but these behaviors can drive you to be completely overwhelmed. We need to keep some sort of perspective and balance here.

Kimberly: 13:45 People are also going out and buying all these products now, from echinacea to elderberry. What do you think about all these?

John: 13:54 Yeah. There’s not a lot of scientific evidence to support some of these things. Clearly, people do things when they’re sick with a cold, vitamin C boosting, and there’s discussions around zinc. At the end of the day, there’s not a ton of backing, but if it makes people feel better, or helps treat symptoms, then there’s no reason … It’s fine, but we’ve got to be careful. These are not scientifically driven treatments. You see the country struggling to figure out how to identify treatments that might work. Remdesivir with this antiviral medication, that has mixed results so far. There’s no silver bullet here. The best measure is to just try to keep the social distancing and hygiene as much as you can. We’ll have to be waiting for the vaccine, which will hopefully come in a year from now.

Kimberly: 14:46 Wow. Yeah, with your family, John, I know you’re a father. You have two little ones and your wife. In your home, are you guys just cleaning surfaces, obviously trying to keep your kids away, homeschooling? What’s going on with your family?

John: 15:03 Listen, my kids have been exposed to information about infectious diseases since they were little. They have coloring books and little dolls of the flu and Ebola, but again, I think trying to keep perspective, they understand the reason why we’re at home and quarantining. It’s all about the greater good, but we’re not driving ourselves nuts either. We’re trying to stay safe and do our part, but again, I think they have a healthy respect for infectious diseases, not some major fear.

We discuss when things will open back up and the possibility of a resurgence

Kimberly: 15:34 Mm-hmm (affirmative). There’s so much uncertainty like we were saying, John, about stress and mental health. People are like, “When is it going to become normal again?” I know it’s really hard to tell right now, because like you said, this is unprecedented. Sample size, everything keeps shifting, but in a best case scenario, when can we hope that things will open up? Do you think school will be opened up in the fall?

John: 16:01 Yeah. My best guess is that it will be. I think that we’re going to be very careful about reopening. I think there will be staging, and there will be a clear sort of analysis of the data at the time. I think we’re going to see over the summer some slow reopening, because I think it’s just not going to be possible to keep populations at this level for a long prolonged time, but we have to do it thoughtfully. It has to be sort of staged, in a way. It can’t just be everything all at once, and as we see data unfolding and that things look okay, then we can start really relaxing the social distancing. I do think schools will reopen. I think there’s going to be a hypervigilant [inaudible 00:00:16:38]. That’s going to be potentially combined some concerns. Our efforts around surveillance are going to be really heightened as we think about the fall.

Kimberly: 16:54 What do you think about talk about a possible resurgence in November, December?

John: 17:02 This virus is here, right? It’s not going to go away. It’s going to potentially have smaller amounts of transmission over the summer, but it’s going to keep spreading until we have this concept of herd immunity. That just means that you have a percentage of the population that has been exposed. When you have enough of that population, then the virus itself starts to die out, because it’s just harder for it to maintain when you have so many people that are immune. That’s what we start going for is this concept of herd immunity, which you keep hearing about. But right now, we may only have 5% to 10% of the population infected, so we have a long way to go if herd immunity is 50% to 70% of the population. We still have a long way to go before we get there.

COVID-19 and your immunity

Kimberly: 17:48 If you get it, are you always immune, or will there be different strains that develop that you are not immune?

John: 17:55 It’s a question that a lot of people are asking. It’s probably likely dependent on how much virus you were exposed to with how much immunity you have. There’s a lot of questions about how much immunity, how long you’ll have it. I think there’s still research that needs to be done. You can’t guarantee that if you had it once that you won’t have it again. Our best guess is that should last at least a year, but those are some big questions that researchers are working on right now.

Underlying risk factors for COVID-19 and immediate steps to take for the greater good

Kimberly: 18:27 Yeah. For the average person, John, thinking, okay, this is around. You want to boost our immunity, but maybe work on some of those conditions like obesity, balancing your diet, the underlying conditions?

John: 18:40 Yeah, right. Those are the underlying risk factors that you have a lot of control over. Of course, not just about risk of COVID, but the risk of all sorts of diseases. Yeah, where you have control, nutrition and exercise is really where you need to focus.

Kimberly: 18:57 Yeah. What do you think about all the testing? Do you think there needs to be more testing, or do you think the focus should just be people focusing on staying home? What are the immediate steps that we can take to really, again, for the greater good?

John: 19:13 Yeah. Well, listen, at the beginning, we should have had a lot more testing. We need more testing now, especially when it comes to essential workers and healthcare providers. I think at some point doing testing of anybody who’s had symptoms, or contact of someone who had symptoms, is important if we’re going to really get into a full control measure. Testing has not been where it’s needed. It’s starting to ramp up finally, but it’s taken a very long time. It should be to the point where everyone who wants one should be able to get a test, and it’s just not-

Kimberly: 19:41 They’re so expensive.

John: 19:43 Right. That should be fully covered by payers, insurers, so that shouldn’t be a burden that people should have to take on.

John shares the idea around his website, COVID Near You, and how you can be supportive

Kimberly: 19:52 Right, right. So John, you started this website called covidnearyou.learn. Tell us about it.

John: 20:00 Yeah. The idea was, to get back to your point about testing, the lack of it, you have no idea of the amount of illness that’s happening in the community because people couldn’t get tested. We know there’s a broad set of symptoms that people are experiencing with COVID, so we created a crowdsourcing tool that was actually based off of a tool that we built for flu called flunearyou, which has had a lot of success. It actually was built after the movie Contagion, which is getting a lot of show. A lot of people are watching it now, but the idea is how do you get people to report their illness, report whether they’re healthy, and basically build a tool to understand emerging hotspots, understand how well social distancing is going. We have this map with over a million reports of people reporting symptoms to us, and then really trying to crowdsource illness and the epidemic in ways that testing just couldn’t show us, because it was so underused. It’s been great. We work closely with the CDC and the public health department.

Kimberly: 20:59 Amazing.

John: 21:00 We’ve had a lot of up ticking, a lot of engagement on the part of people who want to help provide a better view on what’s happening out there.

Kimberly: 21:08 How can we support it if we go on there, and obviously we have symptoms?

John: 21:13 Yeah, covidnearyou.org. It’s very quick. You can see other people that have reported in the site. If you’re healthy, you just say you’re healthy and give a few bits of information about you, like your age, your gender. Then if you’re sick, give us your symptoms, whether you got tested. That helps us really start to understand what people with symptoms are doing, whether they were positive. That’s really helping us understand symptomology, demographic features, risk factors. It’s a great resource, and it only takes a few seconds to engage.

Kimberly: 21:45 That’s wonderful. Wonderful. I see here in your bio, you’re also Uber’s healthcare advisor? I think about that. That must be something people aren’t using at all anymore. We’re not going anywhere, but healthcare advisor, is that having to do with testing the safety of the drivers [crosstalk 00:22:07]?

John: 22:07 My work with Uber actually started years ago with this idea that on demand transportation could be a resource for healthcare, so [inaudible 00:22:17] access to a vehicle is a big determinant, whether you can go see your doctor about your conditions. There’s plenty, huge numbers across the country of people that don’t have access to care because they have no transportation. We built a platform on top of Uber called circulation, which essentially allowed patients to have access to on demand transportation, to get them to their appointments in the same way as other people use Uber. It turns out that that can ultimately change your course of your health, if you can just get access to your care. We’ve been working with Uber and Lyft in innovative ways to utilize their network to support healthcare delivery. We initially started around flu shot delivery. We did on demand flu shots, and then expanded out from there.

Kimberly: 23:02 Wow. Are you being tapped for information to help support the COVID vaccine?

John: 23:10 Yeah. Actually one of the areas where the covidnearyou platform could help is around recruitment of people. They’re going to be looking for a lot of people to get enrolled in trials for the vaccine, and to be monitored, and so covidnearyou could be used as a recruiting mechanism, absolutely.

Trials for vaccines and potential side effects

Kimberly: 23:30 Sounds a little scary, John, trials for vaccines. What about all the potential side effects?

John: 23:37 Well, yeah. Listen, they’re going to do small trials to understand risk factors and understand … Obviously, there’s a lot known about vaccines. This is not a total vacuum, but there’s induced risk, and understanding adverse events in small groups. Once those safety studies have been done, then of course you can start opening up to a broader population. Mostly those studies are going to be to look at whether, in fact, it prevented your infection rather than whether it does anything bad to you.

Children and COVID

Kimberly: 24:06 Right, right. So John, just because it’s top of mind for me about to give birth to another child, it’s interesting that it really doesn’t affect children. Sometimes there’s these healthy adults that do get affected. What is it about children and babies that really does protect them from COVID?

John: 24:30 There have been kids and there have been deaths, but it’s very minimal. We don’t know exactly why there’s … Their immune systems aren’t developed yet fully. It’s possible that there’s some cross reactivity with other exposures of Coronaviruses that kids have not experienced before. Kids are generally healthy. We don’t fully understand, because say with flu, kids could get hit pretty hard, but it’s still something … There’s actually a study that’s happening out of Boston Children’s where I’m based, to understand that more deeply, whether it’s because adults have been exposed to some other virus, which creates a cross reaction, or what is it about the kids’ immune system that is different? So that’s again, a big question a lot of people are asking. It doesn’t mean the kids don’t get it. It also doesn’t mean the kids aren’t transmitting it. They can bring it home to their parents and their grandparents, so that’s still a risk, but they aren’t going to be the ones that are getting super sick from it, which is great news, clearly.

Kimberly: 25:27 Yes. Well, thank you so much, John, for all your wisdom. I’m really excited to … Actually, I did check out already covidnearyou.org a couple of days ago. I’m going to go back on there. Thank you for being part of the frontlines of this. We really depend on researchers such as yourself to really help us out, so great to hear from you, a person firsthand, versus all these … There’s so much in the media. The media should be just somehow more regulated around this. There’s so much fear. There’s so much misinformation. You must get very frustrated.

John: 26:05 It’s a lot. It’s a total frenzy. It’s a total frenzy, and it’s hard to keep up even though this is my area. It’s all day long. Yeah, it’s wild. I can imagine someone who’s not in this domain must feel really overwhelmed by it.

Kimberly: 26:19 Yes, yes. Well, thank you again for this resource. Thank you so much for being with us today. Beauties, we’re going to link to John’s website, which again is ovidnearyou.org . Please check it out and support the efforts to increase research and awareness so we can all get through this as a community, and get stronger together. Thank you guys so much for tuning in. We’ll be back here Thursday for our next Q&A podcast. Until then, stay cozy, stay well, stay at home with your loved ones. We will see you back here very soon.