Debra Fraser-Howze says we must not go back to a pre-pandemic normal. “We died in normal,” said Fraser-Howze, the legendary activist who has worked for more than 30 years on health challenges in the Black community.
Fraser-Howze was speaking at the launch announcement of, and summing up the purpose for, the new Pandemic Response Institute, a city-funded project of Columbia University and the City University of New York.
The Institute’s purpose is to figure out how to harden New York’s public health and social service systems so the next health crisis does not do as much damage as this one did.
The health commissioner, Dr. Ashwin Vasan, said at the event that this moment as “a once in a lifetime opportunity ... to capitalize on public awareness” to invest in public health.
Yet even before the launch event, Vasan’s predecessor, Dr. Dave Chokshi, expressed concern in an interview with Straus News that we might actually be missing the moment for action by already forgetting how bad the pandemic really was.
He vividly remembers visiting the ER at Elmhurst Hospital in those early days “and seeing the terror on not just patients’ faces, but on the doctors’ faces as well. We have to remember what an extraordinary tragedy, it was, particularly, the first wave in New York City.”
It was after that first wave that Mayor Bill de Blasio reached out to Chokshi, then an exec at the city’s hospital system, and asked him to take over the Department of Health and Mental Hygiene.
Frankly, Chokshi said, he had to think about it. He knew how complicated City Hall could be. But how could he look himself in the mirror, he told his wife, an assistant principal, if he wasn’t willing to step in at a time of crisis?
So he took the job, and over the next two years wrestled with the Mayor and his team over everything from mandating vaccines to reopening schools. He came away with a recognition that public health decisions carry so many implications that they need to be made by elected officials.
Which is why it is important that both those officials and the public that elects them have a clear understanding and a strong memory of what happened.
“Four Large Waves”
But instead, Chokshi said that with each new wave of COVID he ran into waves of “collective amnesia,” interfering with a proper response.
“We went through four large waves in New York City,” he explained. “When we were in the Delta wave last year, that’s when it really kind of dawned on me: ‘we’re having the exact same conversations.”
Each time the virus surged the conversation started over, as if we’d learned nothing.
“People would say, ‘well, it’s only cases increasing, let’s see what happens to hospitalizations.’ To me, as someone who’s steeped in this, and particularly to understand the epidemiology, it’s hard not to have your head explode when you feel the public, and in many cases, the political conversation, go in those circles. And you’re like, ‘wow, when are we going to learn.’ And then it happened again for the fourth wave as well. We went through that very same cycle.”
Remembering is not only a matter of honoring those we lost and those who tried to save them.
“The fallibility of the human mind is such that we have this optimism bias, which is good in some circumstances. But it makes me very worried about our ability to actually take the lessons from the pandemic and actually chart a new course.”
We must remember the worst of it, Chokshi said, “in order to have the motivation, and the volition to really change the things that need to change in our city and in our country.”
“Investing in Prevention”
Those changes are big, although not really hard to grasp.
“We have to think about health much more broadly than health care,” Dr. Chokshi explains. “The way that we think about health, so often, is when we are in a time of need when someone is in duress. The whole notion of public health is to say, it’s about all of those times in between, it’s about investing in prevention to actually keep people from getting into the ICU.”
Which is why Chokshi is spending time now writing about the lessons of the pandemic so both health and political leaders will have material to draw from as they think about the next pandemic.
He observes that the “cultural amnesia” about public health crises comes in both short and long term versions.
“In the midst of the 2009 H1N1 epidemic, Historian Nancy Tomes, PhD, laid out lessons learned from the 1918 influenza pandemic, many of which could have served as a predictive guidepost for COVID-19,” Chokshi wrote in an article for The Journal of the American Medical Association’s Forum last year.
Simple things, like social distancing, which helped in 1918, and could have served to do more sooner in 2020 if we had absorbed the practice of separating ourselves when we don’t feel well.
Social and Economic Conditions
But of course social distancing raises major issues of economics and equity, too. Many of the people who suffered most severely in the pandemic, immigrants, the working poor, didn’t have the luxury to stay home. Which is why public health decisions can’t be separated from general social and economic conditions, or from politics, Chokshi notes.
“The 1918 pandemic, as you probably know, historians refer to it as the Forgotten pandemic,” Chokshi said, “because very little actually changed in the structure of society, despite that schism that the flu virus caused back then. And that’s my greatest worry is that we’re not going to leverage this opportunity to make the steep changes that we actually need to make.”
We need to keep remembering so we think bigger and act on those ideas.
“The fundamental question we should therefore ask at this juncture is not ‘how do we patch up what COVID has broken,’ but rather ‘how do we reimagine the role of health in a fair system of social cooperation?’”Chokshi wrote in the medical journal, Lancet in March.
His coauthor was Jin K. Park, a student at Harvard Medical School and Korean immigrant covered under the DACA program for children brought here by parents who entered the country without authorization.
“Seen in this way, all members of society—including immigrants—who play a role in perpetuating the succession of American society over time cannot be seen as peripheral, but rather crucial components.”
The Pandemic Response Institute and other research efforts can identify changes that will reduce the impact of future pandemics. But, in effect, Chokshi is saying that only an informed and willing electorate can give public leaders the mandate, or the backbone, to put those changes into effect.
“The fallibility of the human mind is such that we have this optimism bias, which is good in some circumstances. But it makes me very worried about our ability to actually take the lessons from the pandemic and actually chart a new course.” Dr. Dave Chokshi