The Detroit Free Press on Tuesday published an opinion piece by the leaders of the Wayne State University Center for Emerging and Infectious Diseases detailing the lessons learned so far during the COVID-19 pandemic.

“We're infectious disease specialists at WSU. What COVID-19 has taught us so far,” was written by Marcus Zervos, M.D., professor of Medicine and assistant dean of WSU Global Affairs; Teena Chopra, M.D., M.P.H., professor of Internal Medicine, Division of Infectious Diseases, and corporate medical director of Infection Prevention, Epidemiology and Antibiotic Stewardship for WSU and the Detroit Medical Center; Paul Kilgore, M.D., M.P.H., associate professor of Pharmacy Practice; and Matthew Seeger, Ph.D., professor of Communication, all co-directors of the Center for Emerging and Infectious Diseases.

The piece notes similarities between the COVID-19 pandemic and the so-called Spanish Influenza pandemic of 1918-19, including the lack of coordination between national, state and local governments, health departments and research institutions.

The opinion piece is reprinted below:

Opinion: We're infectious disease specialists at WSU. What COVID-19 has taught us so far
Marc Zervos, Teena Chopra, Paul Kilgore and Matthew Seeger

At the outset of the COVID-19 pandemic more than two years ago, Marcus Zervos, M.D., had recently visited the city of Wuhan in China as part of a collaboration in maternal and reproductive health between Wayne State University and Huazhong University of Science and Technology in Wuhan. This collaboration informed some of our earliest responses to COVID-19 in Detroit.

What we’ve seen since the beginning of COVID-19 were important similarities to the 1918-19 influenza pandemic. The fear, anxiety and conflict about the disease, questions about where it originated and how to treat it, and the personal and political issues that arose were sadly similar to reactions in 1918.

Over time, the similarities between the two pandemics have become even more apparent. Some of the measures to mitigate the effects of COVID-19 were similar to those employed in the 1918 influenza pandemic, including avoiding large gatherings, opening classroom windows and wearing cloth masks. Fear and misinformation also stoked the appetite for very dangerous treatments such as the injection of hydrogen peroxide (1918) or the injection of bleach (2020). 

Equally tragic in both epidemics was the lack of coordination between national, state and local governments, health departments and research institutions.

Infection numbers have jumped by tens of thousands in Michigan, and by millions in the United States and globally. These numbers, as well as the likelihood of future variants, dictate the need to critically evaluate our response and to learn lessons to inform the path forward.

Misinformation kills
In addition to the care of patients and training related to rapidly evolving science, WSU, in partnership with the Mayor of Detroit’s Office and the Detroit Health Department, has helped lead the public health response. This included deployment of testing, participation in contact tracing, outbreak investigation, control of infections among vulnerable populations in nursing homes and homeless shelters, and responding to issues of vaccine hesitancy and vaccine deployment. The work in Detroit was a model for the state and nation. One important lesson from this experience is the need for collaboration between government, health departments, hospitals, universities and community partners. A whole community response is required.

We have seen the devastating impact of misinformation, rumors and poor communication. Sadly, COVID-19 responses have become tied up in the larger mistrust of government, and for many communities, distrust of health care systems. Many have turned to social media as sources of health information rather than to more established credible sources.

The evolving nature of the disease and changing health guidance have been used to support misinformation and mistrust. In the absence of credible sources and consistent messages, rumors have flourished. Many are so outrageous that it is hard to accept that they are believed. This experience yields a second important lesson: Communication matters.

For decades before COVID-19, Detroit communities faced serious health inequities associated with race and income. These disparities have compounded challenges in mounting a comprehensive response to the pandemic in Detroit and many other communities. COVID-19 has vividly demonstrated the devastating impact of underlying health conditions, lack of access to health care, inadequate transportation, poverty and a history of discrimination.

This experience yields a third lesson: Public health disparities impact our entire community and no one group can remain isolated and unaffected as pathogens know no borders.

Preparing for next time
Our public health system was unprepared and ill-equipped to deal with a major epidemic that quickly became a global pandemic. An inadequately prepared public health system at the local, state and national levels meant that our surveillance, case detection, case follow-up, contact tracing and diagnostic capacity were slow and insufficient, making control and containment impossible. Critical resources, supplies, equipment and personnel were in short supply, made worse by disrupted distribution systems. All of this highlights the urgent need to greatly enhance and strengthen the public health infrastructure (e.g., laboratories, buildings, supplies) as well as the human capital in trained personnel and multi-disciplinary expertise so we are much better prepared to respond efficiently and comprehensively to the next epidemic or pandemic. This enhanced infrastructure includes major initiatives such as the new WSU Center for Emerging and Infectious Diseases. Learning the lessons of public health preparedness requires investments in facilities, training, planning and people.

A final lesson concerns the transition from a pandemic to an endemic disease state. We will not be able to eradicate COVID-19 because of the virus transmission characteristics. We need to learn to live with it. This means building public health response locally and globally, dealing with political issues, building greater trust, eliminating social and racial health disparities, instituting risk migration, health education and communication strategies, expanding scientific efforts and strengthening capacity for response for low-income countries. Hopefully, the lessons learned about optimal public health response, including building the infrastructure for laboratory surveillance, the ability to conduct prompt contact tracing and outbreak investigation and control, mechanisms to provide testing, and better addressing vaccine hesitancy. We must be able to respond not only to COVID-19, but to other emerging organisms by having appropriate infrastructure, expertise and policies that enable rapid, sure and coordinated public health responses.

Despite the tragedy and devastation of COVID-19, we must remain hopeful. Over time, influenza became a manageable illness with vaccines and effective therapies. The history of the 1918 pandemic provided important lessons as later waves of disease became less deadly. The hope is that the wait for effective and coordinated public health measures during a pandemic is over and that the 100-year cycle of tragedy and forgotten lessons has ended. We have improved vaccination rates and devised better treatments for COVID-19. Omicron appears to be less deadly than earlier strains of the virus. If we learn these and other lessons, our post-COVID-19 pandemic world will be more resilient, health disparities will be reduced and our public health system will become stronger.

Marc Zervos, M.D., Teena Chopra, M.D., M.P.H., Paul Kilgore, M.D., M.P.H., and Matthew Seeger, Ph.D are co-directors of the Wayne State University Center for Emerging and Infectious Diseases.