Denis Nash: an academic soldier in the pandemic
Denis Nash, a distinguished professor of epidemiology at the CUNY Graduate School of Public Health and the executive director of the CUNY Institute for Implementation Science in Population Health, researches COVID-19, testing methods and the effect the virus has on stress and mental health. He was recently quoted in a damning New York Times piece about the state’s vaccine rollout.
Nash recently spoke to Clarion Editor Ari Paul.
There’s been a lot of news about the vaccine rollout in New York. What do you think the main problems have been?
A major flaw is centering vaccine distribution around an appointment system that is not under the control of the government of New York. It is first come, first served, setting up a situation where appointments made are not aligned with what is needed for public health within what I would call very broad categories of eligibility. There is not enough vaccine right now and community transmission is high at the moment. People have and will be hospitalized and die of COVID because they couldn’t get vaccinated in time.
When you can’t vaccinate everyone at once, you wouldn’t want to vaccinate all the 65-year-olds before all the 75-year-olds, or all the younger teachers without comorbidities before the older ones with comorbidities. This is what the current system does, among other things that virtually guarantee inequity when it comes to this amazing public good. But any time you have a public good that is in short supply, the benefit will be unfair unless you put some guard rails on the system that provides it.
How could it be done differently? The state could ask people to sign up and provide their personal details (age, comorbidities, race/ethnicity, geography, other demographics, other eligibility info, and contact information) and enter everyone into a virtual queue. That queue would be tapped every week according to the number of vaccine doses available and in the order of priority/need, including priority access to those living in communities and from demographic groups that are hardest hit.
A lot of parents are eager to get their kids back in schools. In your estimation, can schools safely reopen?
In some cases, yes, but it is important to consider what we mean by safe and for whom we mean safe. There has been a lot of discussion about how there is not a lot of evidence of transmission in elementary schools. If that is true, it is a great thing. Some of the city’s surveillance testing suggests it might be true. However, when I think of what safe means, it includes how much increased risk there is among students, their families, teachers, staff and administration with schools open compared to the risk to all these folks when schools are not open.
If you think about it this way, you realize that, even if a school is safer on the inside (good ventilation, enough space to distance, good mask wearing adherence, etc.), you also have to consider the risks associated with going to and from the school for all the students, their families, teachers, staff and administration.
In addition to research like your own, what role can CUNY play in fighting the pandemic?
CUNY could be doing more to get ready to go back to in-person learning and to support our students to help bridge them through what has been a very difficult year. There could be a lot more communication around plans for in-person learning and vaccination. I have not really heard anything from CUNY and its plans to help faculty, staff and others in our community stay safe and/or get tested and/or get vaccinated, beyond what is on the state and city websites.
People are interpreting the guidelines differently, and I really wish CUNY would clarify things here, as well as tell us how they plan to help ensure those of us who are eligible for the vaccine can receive it before we are expected to teach in person. That would be more in line with what other universities are doing.
You’ve done a lot of work on HIV/AIDS. What do you think we can learn from that crisis to get us through this one?
It is very interesting that a lot of researchers and epidemiologists who have dedicated their careers to addressing the HIV/AIDS pandemic, are also working on the public health front lines of the SARS-CoV-2 pandemic. I think this is because there are a lot of similarities and lessons from how we have tackled the HIV/AIDS pandemic that are relevant to this one.
The first one is how rogue and inept politicians can have such an outsized influence and role in steering us into utterly avoidable public health devastation. The second one is how fear and stigma can divide us when we really need to be united and care for one another. And there is the importance of prevention and testing – the need to rapidly advance science to increase our understanding and capacity to adequately respond and address all the dimensions of havoc that this pandemic has brought upon us.
Working-class communities and people of color seem to be highly at risk in this pandemic. What kind of policies do you think we can implement to address that?
In my view, we have done so much to try to control this pandemic and to reduce its impact, but there have been no targeted efforts to address the risk among those who are bearing a disproportionate burden of disease and death. Namely Black and Hispanic communities, and essential workers (and others who need to work). It is incumbent upon government leaders, public health leaders, decision makers and policy makers to anticipate and proactively design pandemic response implementation strategies and metrics/targets that account for and counteract the fundamental and prevailing structural forces that will, without fail, otherwise create, perpetuate, or exacerbate inequities in safety, health and well-being.
There is a lot in the control of government that can help protect those that they have been unable to protect to date. Keeping community transmission low, increasing workplace safety, increasing access to testing for essential workers and their household members, ensuring that public transportation is safe and incentivizing isolation and quarantine when the need arises. Most importantly, we must ensure the vaccine rollout doesn’t leave the hardest hit communities behind again.
Some of your research has focused on the effect anxiety has had in the pandemic. What should readers know about that?
The pandemic is taking a mental health toll on a large number of people who are affected by the pandemic and all of the hardship and stress that comes with it. Our own research at CUNY in the “Chasing COVID Cohort Study” has found that the levels of anxiety and depression are much higher than would be expected had there not been a pandemic. Overall, 35% of our participants had moderate to severe anxiety, which is high. Even higher levels of moderate to severe anxiety were reported among people who have had COVID, have family or friends with COVID, and people who worry about getting COVID themselves or worry about a family member getting COVID. In addition, people who have experienced job or income loss as a result of the pandemic had higher levels of anxiety, as did those with a prior diagnosis of depression.
We are also finishing a small study that focused on educators. Between September 8, 2020, and November 17, 2020, we recruited 469 educators into “The Educators of America COVID Cohort (TEACCH) Study”: 41% had moderate or severe anxiety and 37% had moderate or severe depressive symptoms.