Lessons From COVID-19
Just as COVID-19 has impacted nearly every aspect of life, so too has it affected the direction of research in countless ways. From faculty who stepped up to contribute to the emergency response to those who found themselves in the midst of an unprecedented natural experiment, UMass Amherst researchers have studied the pandemic’s influence from a variety of angles. Several faculty members shared lessons learned and implications for the future.
Learning to Pivot
Of all the populations and systems affected by COVID-19, the medical community undoubtedly experienced some of the greatest strain. Beginning in March 2020, Sarah Goff, School of Public Health & Health Sciences (SPHHS) associate professor and a practicing internal medicine and pediatric physician, and her students began interviewing healthcare providers about their experiences during the pandemic. The stories they heard revealed a general lack of preparation at the national level for such a large-scale emergency.
“Some of the stress points that have long been present in a host of systems started to crack,” said Goff.
Yet, they also heard about successes—of emergency room care providers coming together and learning to work differently. The medical field tends to be a conservative one, in which protocols are rarely changed without a great deal of study and discussion. This is generally an important process to ensure safety. Yet in many ways, the emergence of the novel coronavirus required the medical community to be agile—to quickly reconsider and revise certain long-held practices, often studying the results as changes were being implemented. For example, said Goff, standard treatment protocols for respiratory distress call for intubation if a patient’s oxygen drops below a certain level. But through discussions amongst an international Twitter network of emergency room doctors—started by a Baystate Health doctor to share information and practices—it became clear that patients were faring much better when intubation was avoided and different types of interventions were used instead. The medical community rapidly implemented new protocols for COVID-19 patients in respiratory distress, saving many lives.
Outside the ER, Goff pointed to the emergence of telehealth during the pandemic as another potentially positive development. For years, efforts have been made to introduce telehealth visits for a variety of concerns, including those related to mental health, but issues of policy and financial reimbursement got in the way. COVID-19 lockdowns finally compelled the system to remove these barriers, and telehealth became widely available.
Goff views this as a largely positive change, but she noted that it didn’t necessarily increase across-the-board access to care as hoped, due to inequities in access to equipment and high-speed internet access.
Issues of inequity in health care delivery and quality of care are another focus of Goff’s research. Here again, the pandemic shone a light on existing systemic problems, with many communities of color suffering a disparate impact from COVID-19 in terms of hospitalizations and deaths.
Goff said there are many possible underlying reasons for these disparities. Patients may be reluctant to seek care if they have language barriers or are fearful of an undocumented status being discovered. Or, they may have had negative experiences in medical settings in the past. For example, research shows that Black patients tend to have their pain undertreated compared to white patients.
Unfortunately, Goff said, the problem is understudied and there are no easy answers. She advocates for community-based research “to learn directly from patients what the problems are and how to address them. We need to find public policies that change the structural contributors to inequities in health and health care.”
“Educate, Educate, Educate”
Wilmore Webley, associate professor of microbiology in the College of Natural Sciences, has been working to connect with members of the Black, Latinx, and other underserved communities since early 2020. To date, he has given more than 100 virtual presentations all around the U.S. and the world, and continues to deliver more every week, all in the service of educating individuals about the virus and COVID-19 vaccines to promote safe behavior and increase vaccination rates. (Watch an example of one of Webley’s presentations to the Black Springfield COVID-19 coalition.) Webley, who is also director of pre-med advising and incoming associate dean of the Graduate School’s Office of Inclusion and Engagement (OIE), was honored at a Springfield Juneteenth event for his work on COVID-19 education with the Black Springfield COVID-19 Coalition.
Webley said most of the people to whom he speaks are vaccine hesitant but are being targeted with misinformation by anti-vaxxers.
“We must educate, educate, educate to counter the misinformation that has been targeted at African Americans,” said Webley. This requires ongoing, systematic engagement—Webley often leaves his phone number and email address for individuals to follow up with questions or concerns—as well as working with trusted local leaders in community groups and churches.
Through his talks, Webley seeks to share accessible and accurate scientific information about the virus and vaccines, while addressing long-standing distrust of medical authorities amongst African Americans. This stems from both historical exploitation by the medical community—from gynecological experiments performed on African slave women without anesthesia to the infamous Tuskegee study of untreated syphilis in non-consenting Black men—as well as present-day inequities in treatment of Black patients. In his presentations, Webley always begins by acknowledging these realities. He also seeks to build confidence in the vaccines by describing participation by well-known African American doctors and scientists at every step of the development and approval process.
Webley said it’s important to remember, “Distrust in the African American, Hispanic, and Native American populations did not develop overnight. They have endured centuries of abuse and exploitation by medical professionals who said, ‘You can trust me.’”
During the pandemic, some communities offered vaccines first to minority groups, who were often hardest hit by COVID-19. Webley said this was a serious mistake, as it created the impression that, once again, people of color were being used as “test subjects.” Webley also noted that large vaccination sites were often in locations inaccessible to lower-income individuals without cars.
“You have to meet people where they are,” he said, recommending that vaccines be offered in grocery store parking lots, barber shops, and hair salons. Connecting vaccination sites with these familiar establishments can also help build trust in the vaccine.
In terms of generally growing confidence in health care, Webley said, it is crucial to increase minority representation in the ranks of doctors, which remains extremely low relative to the general population. In addition, Webley points to the importance of programs like Population-Based Urban & Rural Community Health (PURCH), a partnership between the University of Massachusetts Medical School and Baystate Health to help medical students learn directly from underserved communities about the complex social and environmental factors that affect them.
Finally, addressing structural issues in healthcare is only one small piece of the puzzle, said Webley. Social determinants—such as income, one’s home community, quality of social support networks, access to healthy food and time to cook, among many other factors—can affect around 80 percent of health outcomes.
“All of these things are hard to change,” said Webley. “They take time and investment.”
Forecasting the Future
When the first cases of COVID-19 were reported in the United States, it was difficult to predict just how quickly the virus would spread and cause mass fatalities—over 100,000 deaths in only the first four months. Developing accurate forecasts was necessary to guide critical decision-making. From governments officials determining public health guidelines to hospitals evaluating staffing levels to schools and workplaces deciding whether and when to open in person, it all hinged on understanding the trajectory of the virus.
Very quickly, the Reich Lab, directed by UMass Amherst SPHHS Associate Professor Nicholas G. Reich, stepped up. The lab had worked closely with the U.S. Centers for Disease Control and Prevention (CDC) on its FluSight seasonal influenza forecasting since 2015, and in 2019 was designated as one of two nationwide, CDC-funded Influenza Forecasting Centers of Excellence. In March 2020, Reich and his research team pivoted and founded the COVID-19 Forecast Hub, which established itself as the authoritative source of predicting new COVID-19 cases, deaths, hospitalizations, and cumulative deaths. This effort, developed in close coordination with the CDC, delivers the numbers that appear on the CDC COVID-19 forecasting site every week.
Since then, every week dozens of modeling teams around the country have submitted predictions, which Reich and his collaborator, Research Assistant Professor Evan L. Ray, along with a group of students, faculty, and staff, have aggregated into an ensemble forecast. The COVID-19 Forecast Hub produces forecasts for between one and four weeks out at the national, state, and county levels, which the CDC uses to communicate to the general public.
According to Reich, this work was a natural outgrowth of his lab’s experience forecasting seasonal influenza, yet for COVID-19 “the scale of data collection is massively different.” Over the past 15 months, the team has worked to aggregate data from about 80 different teams and 100 different models, which collectively have yielded over 56 million unique predictions about the future. This work has been done in real time, under a national spotlight. For many months, the Hub’s website received over 1,000 views per day, while the same information posted on the CDC’s site was undoubtedly viewed by many more. The predictions have been regularly cited by high-profile news outlets, including The New York Times, Boston Globe, CNN, and NPR.
While many infectious disease modelers aim to develop a “silver bullet modeling methodology” using new cutting-edge computational techniques, Reich’s lab has been on the forefront of aggregating predictions from numerous different models and research groups. This approach has proven to be exceptionally accurate. In February 2021, Reich and colleagues published preliminary findings on medRxiv showing that for COVID-19 forecasting, “The ensemble was the only model that ranked in the top half for over 75% of forecasts it made.”
Reich hopes that the success of the aggregate model for COVID-19 forecasting will be carried on in the future at a national level with regards to a wide variety of public health concerns.
“My hope is that the framework we’ve operationalized here will serve as a prototype for these kinds of efforts going forward—not just for forecasting COVID-19 or the flu, but for thinking about the evolution of viruses more generally,” he said. “There are all kinds of predictions that researchers can extract from models, and we should always be relying on aggregated results to answer important questions.”
Preparing for “Just in Case”
In the early months of the pandemic, Americans nearly universally experienced difficulty obtaining essential items. From hospitals unable to access critical PPE needed to protect healthcare workers to consumers facing empty grocery store shelves and widespread shortages of basic cleaning supplies and paper goods, COVID-19 sparked a supply shock that hasn’t been seen in generations.
Anna Nagurney, the Eugene M. Isenberg Chair in Integrative Studies at UMass Amherst’s Isenberg School of Management, is an expert on supply chain networks and disruption management. She said the experience during the pandemic has been distinctive because it is not limited in time and place like most natural and technological disasters affecting supply. Though some may think of the pandemic as a once-in-a-century event, Nagurney believes that we need to take its lessons seriously. Climate change is causing more frequent and more severe disasters, while the globalization of supply chains means we are all more interconnected than ever before.
For Nagurney, the pandemic illuminated the risks inherent in “just in time” manufacturing, an efficiency practice many U.S. companies adopted from Japan in the 1980s to save money by keeping inventories low. Instead, she sees a need for “just in case” planning, or preparing for worst-case scenarios.
This experience also revealed the dangers of relying too much on other countries for vital products and natural resources. The U.S. has depended on China for much of its PPE and other medical products, and on India for generic drugs. Both countries were hit with devastating outbreaks at different points in the pandemic, affecting access to these critical products in the United States. Nagurney said companies must strengthen relationships with suppliers, and work with multiple suppliers for critical components in order to boost resiliency.
“Companies must emphasize agility, business continuity, and strengthening of relationships,” she said. “They really need to protect their workers: pay them what they deserve, create safe working conditions, and make sure they’re productive.”
Nagurney is heartened that President Joe Biden is taking this matter seriously and has appointed a Supply Chain Disruptions Task Force to explore vulnerabilities and promote economic and national security. She noted there is bipartisan momentum around investing to make the U.S. less dependent on other countries for important products and raw materials, such as rare-earth elements and computer chips. Nagurney also sees a need for major investments in critical infrastructure—roads, bridges, internet and communication systems—which are also important components of the supply chain network.
And while Nagurney acknowledges that all this costs money and may raise retail prices, she believes consumers, especially younger ones, care about “companies doing the right thing for the planet and social causes.”
“We have learned a lot and continue to learn from the pandemic,” she said. “The resiliency theme is resonating with a lot of people.”