Outdoor Transmission w/ Dr. Theresa Chapple
Dr. Theresa Chapple 0:01
Every time we talk to people and let them know that they have been exposed or that their case has been linked back to an event that they attended outdoors, the response I got every single time from every person was, I didn't know you could catch COVID outside. That is alarming. That means that we are not doing a good job. We in public health aren't doing a good job with getting the messages out there that yes, this can happen. And yes, it does happen.
[intro music playing] 0:29
Beatrice Adler-Bolton 0:55
Welcome to the Death Panel. To support the show become a patron at patreon.com/deathpanelpod . We do two shows a week. Our Monday episode is a patron exclusive, which will sometimes get unlocked in an emergency like last week when I was in the hospital. So if you'd like to get access to all of our bonus episodes, like my interview with Tracy Rosenthal, about Los Angeles's homeless industrial complex, become a patron at patreon.com/deathpanelpod. And if you'd like to help us out a little bit more, share the show with your friends, post about your favorite episodes, preorder Health Communism or request it at your local library, and follow us @DeathPanel_ . So I'm really excited to welcome our guest to the show today. Dr. Theresa Chapple is an epidemiologist with extensive experience working not in an academic setting, but on the ground in the field. Dr. Chapple, welcome to the death panel, I can't tell you how much I appreciate you taking the time to join me today.
Dr. Theresa Chapple 1:52
I am so excited to be here. I've listened to you guys throughout the pandemic, you've had some of my favorite people on here.
Beatrice Adler-Bolton 1:59
Awww.
Dr. Theresa Chapple 1:59
To be a part of this is awesome for me.
Beatrice Adler-Bolton 2:02
The mutual admiration society.
So I've asked you here today to share with us some of what you've come to know about COVID transmission through your direct epidemiological investigations and public health work throughout the pandemic. Specifically, I was hoping to speak with you a bit about outdoor transmission. You have been vocal on this and also shared on Twitter that you've personally investigated instances of this happening yourself. But first to start us off before we get into that. Would you mind talking a little bit about your background? What led you into the role that you're in now, I guess pre pandemic? What was your work like? And how did it shift during the pandemic leading you towards the position where you're in now?
Dr. Theresa Chapple 2:42
Sure. So I am an epidemiologist by training. I have PhDs in both epidemiology and in maternal and child health. And so I have, my background has tended to be in pediatric reproductive epidemiology, and making sure that those groups, those populations stay as healthy as possible for as long as possible. So I actually spent a lot of time looking at risk factors for pregnant people, risk factors for their fetuses and their children, all the way up to probably between the time that people are thinking about getting pregnant until that child is 25. And then it's time for that age group to start thinking about getting pregnant. So I kind of work in that lifecycle of diseases, what can be prevented. And how to make sure that people are as healthy as possible throughout those stages of life.
So that brings me to the pandemic, right? How did I get here?
Beatrice Adler-Bolton 3:39
Right.
Dr. Theresa Chapple 3:39
Well, early in 2020, it was the thought process that children don't get COVID.
Beatrice Adler-Bolton 3:44
Right. Right. Of course, that was the, that was the sort of first truism that that emerged throughout the pandemic is before even the discussion of it being mild, right, was that children don't get COVID. They're, they're sort of magically protected.
Dr. Theresa Chapple 3:56
I have never met a disease that, you know, I've never met an infectious disease that skips over children. So I thought that that was just really one interesting thing that maybe people like me needed to dig into, people who have an understanding of children and childhood and childhood diseases. And what I started asking was, maybe it's not that children don't get COVID, maybe childhood COVID looks different from adult COVID. And we need to start thinking about it in those terms. We think about things like childhood asthma, we think about childhood leukemia, we think about all these other diseases, and we put the terms childhood in front of it because it presents differently than the adult version of that same disease. So maybe that was what was going on with COVID.
And that took a lot of pushing in the field, and in medicine, and everywhere to get people to think, well, maybe we shouldn't be withholding COVID tests from children. Maybe we should test these children to see if they have it instead of just running with the idea that children don't get COVID. So it was a whole lot of kind of proving that children get the disease, and then trying to say, well, okay fine, we believe that children get it, but children can't spread it.
Beatrice Adler-Bolton 5:15
Right.
Dr. Theresa Chapple 5:15
Well... like... okay, well that doesn't make sense either. But let's, you know, let's now prove it. One of my pet peeves kind of throughout this pandemic, in terms of the way, the entire way that this pandemic has been done, is that it's been every step of the way you have to prove that something happens. We don't do that with other things. We don't say, you know, an airplane can only crash at this one spot, because we've seen it crash here, it can't crash two feet from here, right, we don't constantly make it that we have to prove that an aeroplane can crash all the way along its flight path, in order for us to care about the fact that the airplane crashed. But that is exactly what we did with COVID, we made it where we had to prove that COVID could happen at every single place before we could care and put mitigations in place at those places. And so this has been like, just a major frustration of mine, all the way through the pandemic. And that brings us to now where we are where we can accept that children get COVID. We can accept that children can spread COVID. We can accept that children can get sick enough from COVID for it to be a big deal. And maybe we should be concerned that children can get long COVID. That's kind of where we are right now in the whole children and COVID era. But this brings us to like the next phase, where like, okay, I can leave the children and COVID thing alone. And now I can be the one sounding the alarm on outdoor transmission. Because we really want something to be COVID safe. Right? And...
Beatrice Adler-Bolton 6:26
Yeah, absolutely. I mean, that's the that's supposedly the goal, right?
Dr. Theresa Chapple 6:55
We're all so tired of COVID. And I tell people like, I am probably one of the most tired people out here. COVID has been taking over all aspects of my work. And it really should just be one component. And so I am tired of COVID too. I want COVID to go away. I want a safe place to be where I am not worried about my child under the age of five, who's yet to be vaccinated, contracting COVID. So the idea of going outside and interacting with people outside for socialization. And just for some normality is something that I would love to just take and grab on to and be able to do with no concern. But that's not where we are.
Beatrice Adler-Bolton 7:40
Yeah... I liked the way that you've framed it in terms of having all... having to sort of claw back all of this work, all of this intellectual labor, it's been years now of trying to force this kind of idea of: 'No, we actually have to look at COVID in children.' And I, you know, I think this is one of the wins, actually. And this is something that like, it might feel like it's sort of a difficult and still contentious area. But we've certainly, I think, gotten really sort of far recently. And one of the things that I worry about, right, is that we have at least there is some legibility and understanding that within school buildings, you know, there needs to be something in place to keep children from just, you know, being sort of in the path of like a let it rip strategy. But now as we're transitioning to summer, and we're transitioning to, you know, maybe kids being at camp or people being outside, there's this kind of like, there's this kind of like, truism, right, this new truism, as you're pointing out, and it's this kind of idea of like, when you're outside, specifically, outdoor transmission, that COVID does not spread outdoors, full stop, like at all that outdoors is a safe zone. You know, the idea is, like, if you're playing a game of tag, right, and as soon as you get out of the building, you're safe. And sometimes you see this in the most ridiculous way, like when I'm leaving the pharmacy, and the pharmacy is already, you know, a mess, because you've got test to treat people in there. And people without masks and people picking up prescriptions. And you know, when people shopping, and when they get into the double doors exiting the Walgreens and you have the sort of sliding glass doors or something, they'll get into one sliding glass door and rip their mask off. Like it's some sort of like, you know, special pressure seal, that they've crossed the threshold, right. And there's this kind of, and we've made fun of it a lot in terms of when you know, people were sort of setting up these elaborate dining huts and assuming that even though if you put up a bunch of plexiglass, that somehow would be fine because it was outside in the street, but outdoors, like in a park, for example, or at a sports game, like these are the kinds of scenarios that people have deemed, like green zones, totally safe. And I think that one of the things that you know, you're asking and that you were asking on Twitter, which is why I'm so glad that you're here. It's sort of like, well, I guess where are these assumptions coming from, right? Because, if you look at sort of what's going on, that's not necessarily the case. And from your perspective, I mean, you've, you've investigated instances of outdoor transmission. Before we get into specifics, like, let's do the basics, right? Like, is it possible? Can you catch COVID outside?
Dr. Theresa Chapple 10:18
So one of the things that I think is extremely important, kind of, for us to remember throughout this pandemic is that science is the science, right, like these are the proven facts. And aerosol transmission is one of those proven facts. And that, yes, you it doesn't change. If I'm talking to someone, and we're right face to face in front of each other, and one of us has COVID and the other one doesn't, like the transmission is going to happen, or it's likely to happen. There are definitely scientific mechanisms and pathways for that transition to happen. So to me, for people to really think that that is not a possibility just makes me question how well we do science in America. How well are we teaching people the basic skills that they need to know in order to have these conversations? And so I think it's really like studying at the basic building blocks, like, can't you smell smoke outside? Can't you? Out of that instance these are these weird things that that I find it hard to to understand. But I do. I think the problem comes from people not understanding the difference between low and no.
Beatrice Adler-Bolton 11:38
Yes.
Dr. Theresa Chapple 11:38
And that has happened throughout the entire pandemic, where children are at a smaller risk or less or lower risk. And people have interpreted interpret that to mean no risk. And then one of the words that we use all throughout that I absolutely hate, is the word safe. Because safe means without risk, right? And so if people are using safe, then yeah, then you think then that means that there's no risk, because this is safe, we should really look at the verbiage we use, we should make sure that people are understanding the differences. At one point in the pandemic, they were saying that outdoors is 19 times less likely for transmission. Okay, that's great. We can put a number on it. That's nice. But what does that mean to someone who's not a scientist? What would that mean to my mom? How would she take that and interpret that and then go into the world and act? So I think we really need to look at our messages, see what it means to normal people and see if that's what we're really trying to get across? I think if what we're trying to say is, outdoors is better than indoors, we can say that.
Beatrice Adler-Bolton 12:46
Right.
Dr. Theresa Chapple 12:46
But we can still say that there's a risk associated with interacting with people when we're dealing with a pandemic, that is airborne. Right. And I don't think that that message stays. That's not something that people still understand and are holding on to right now.
Beatrice Adler-Bolton 13:03
Right? I mean, that position or even like holding open for that position is treated as alarmist by some people. I mean, if if you post about this, right, like you get people who bombard you or at least I get people who will send me messages that are like, if you look at every randomized control trial, it says masks don't work. And, you know, it really brings out the bullies, and they're like, you know, show me an instance of outdoor transmission. Show me this sort of example of the plane crash, which I really liked that one, I hadn't actually heard that that metaphor before. And I really appreciate it, by the way, but you know, you've got this kind of, right, this burden of proof that's like, pushed on anyone who's really just coming from the perspective of like, well, if we take what we know about COVID in one arena, and sort of apply it evenly, then it would make sense that you could get COVID indoor and outdoor, right? But I think one of the things that we've seen is that there's this sort of fundamental misunderstanding about like, how you catch COVID, right? So maybe the thing that sort of, is the actual conversation here, right, is that is like how does one become sick with COVID? How do you actually go from being in an environment of sort of being around virus to being sick? I mean, this is something that you've studied, and you've tracked, do you mind walking me through it as if you're telling it to me for the first time? I'm someone who's been, you know, not paying attention or something, and I've just, you've sent this to, like, my friends sent this to me, right? And they're like, listen, please, like, I want you to meet up with me outside, but I need you to wear a mask and like, here's why. Like, I think we want to be able to take those people, right, and bring them to the point that we were able to bring people on understanding what's going on with kids and COVID. And I think it's one of those things that you just can't find access to right now, in the media, basically anywhere.
Dr. Theresa Chapple 14:50
I think we have to just keep reminding people that it's those close contacts, it's those frequent contacts, it's the bringing... Like the virus is looking for access to your body, right. So that's gonna happen to you about those times. And if someone has the ability to breathe on you, then that is the way that you can contract the virus. And that can happen indoors because the virus can be trapped there. And it can accumulate faster in an indoor setting. Outdoors, there's space for it to kind of move. And that is the thing that makes it that lowers the risk. But it's not the thing that takes away the risk. And because the risk is not taken away, we should also do something to help mitigate that risk. And that something could just be as simple as wearing a high quality mask, when you're outdoors in a crowded setting where you don't have the ability to distance and you don't have the ability to to control who is in your environment who you're coming in contact with. And to me, these are really simple truths that could be easily instituted. And I totally get that as the hotter summer gets. And as the more humid summer gets, the more you don't want to wear your mask outdoors, because it could be more uncomfortable. I appreciated wearing my mask outdoors in the winter, it was better than a scarf. And so I think it really we need to look at what are some barriers, and we can talk about those we can figure out ways to help people work around this. So that it's not the only option is to just take your mask off and and chance it.
Beatrice Adler-Bolton 16:36
Right, so you know, I mean, what's sort of what's going on when people actually like become sick with COVID? Because I think one thing that people are really concerned about when they're they're like thinking about outdoor transmission is that they don't know like how much virus actually can get them sick. And this is I think something that is an unknown, right? But between that being an unknown and the fact that there wasn't a lot of tracking, of like, tracking and reporting of this early on, I think we've just, as you're saying, we've interpreted it as no risk. But you know, if you're someone who's like, I don't know, if you're just like sort of trying to explain to someone else, like, what the importance of needing to mask outside is. I think people often demand wanting to know, sort of like, well, what's the reason right? Or what's the sort of need for it? And I mean, it's, it's difficult, because it's not like, it's not like we actually have the evidence, per se, right? But what we know is like how the virus behaves and how it moves in the air and how people become sick, sort of, regardless of what environment they're in, when the air is like not moving, you know, and there are plenty of weather conditions where that can happen outside as well as inside.
Dr. Theresa Chapple 17:44
So I have recently investigated or helped others investigate six different outdoor outbreaks. And I think that, you know, when it happens, then I'm thinking back to last summer, when there was an outdoor festival in Europe, and it led to a major outbreak. And people were all shocked that it can happen. And that happened as well with the six that I just investigated with some colleagues. And every time we talked to people and let them know that they have been exposed or that their case has been linked back to an event that they attended outdoors. The response I got, every single time from every person, was I didn't know you could catch COVID outside. So it was really like to me, that is alarming. That means that we are not doing a good job, we in public health aren't doing a good job with getting the messages out there that, yes, this can happen. And yes, it does happen. And so there's one piece, I am a applied epidemiologist, that means I don't work in an academic setting. And the research that I do, I put into practice immediately. And so I'm able to take like the results of a study that I do, and then just go ahead and communicate it to the communities that I'm working with, and help them make whatever changes necessary. But that is different than what happens on the large scale when you have academic epidemiologists who then publish these results, they become big stories. And then larger populations get to have access to this data and this information. And so I think that that's one of the pieces that's needed is that we need to, applied epidemiologists, people like me need to continue to link with academic epidemiologists to get this information out there as far as possible so that people can stop saying that they didn't know, because that's saying they didn't even know that it was a possibility. And then hopefully, that can help and put pressure on different organizations because there are large organizations that people listen to, that can easily come out and say, if you're going to be playing softball, then when you're in the dugout, you should mask because you're going to be really close to people, you're planning there, you're talking, you're figuring out your next steps. That's a high risk situation that happens in an outdoor setting. So at least wear your mask in the dugout, right? Like, there are some clear messages that could come out that we know. I'm thinking back to like April of 2021. Dr. Walensky, came out and said that the nation was seeing a lot more COVID cases, and they were being linked back to sports. Some of these were outdoor sports. And it would be really clear to say like, this is the situation in which made the outdoor sports a risk factor for spread. But that hasn't happened, and people haven't caught on to it. And yet, we had a whole other spring season, where the nation as a whole saw an increase in COVID cases, most likely linked, again, to outdoor sports. And yet, there was nothing said about this surge, there was nothing warning us that we knew that this would come, we knew this would happen. And we also know what the links are. And these are some things you can do about it. This time around, by the time we got to April of this year, we talked about, you know, 95% of the country doesn't need to wear masks indoors, let alone outdoors. So...
Beatrice Adler-Bolton 21:22
Right, the position that we're in right now is like abysmal. And I think a lot of people are kind of in the in the moment where they feel like, you know, outdoor transmission is maybe the furthest thing from their mind, because not only, like, is there this sort of understanding that it's no risk. I think a lot of people don't even really know, like, what's safe. And I think, you know, what's clear to me is that essentially, like, if you were to be making these recommendations right now, you would be making the same recommendations for when people should be masking for like both indoor and outdoor, right, which is like when you are in a really tight space with other people. And that can occur, like regardless of sort of whether there's a roof or not, you know, obviously like you balance all these other diseases at the same time with COVID. I can't imagine that like there are ever like enough resources for applied epidemiologists who are actually like working in the field. But, you know, I think one of the things that COVID is really doing that scares me. And I'd be curious to hear if you have thoughts on this as well, is you know, the fact that it takes up all of this time, right, that that would have been like spent working on these other diseases, right? And we're spending all of this time and energy fighting these sorts of battles over, you know, it's very small things that you would think would have been just like, really just regular and obvious. But I feel like a lot of these obvious things about COVID are just sort of still unsaid. So do you have like a top, you know, couple of obvious things about COVID that you wish people knew more surely or more confidently than you feel like people have sort of baked into their understanding of how the virus works?
Dr. Theresa Chapple 22:53
I think a lot of the misunderstanding comes from changing guidance and changing rules along the way. I feel like people understood COVID, I felt like the general population, general public, understood COVID better the summer of 2020 than they understand right now. So my top line that I tell people all the time, is that you can still be infectious after five days. I think that that is the biggest thing that people just really either don't know, or don't want to know, they want to return back to life as usual on day six, and keep it moving. But over and over again, I'm telling people that you could still be infectious and that you should possibly take a rapid antigen test in order to leave isolation and not just leave it because of the day that you're on. My... I have a relative right now who has COVID. And I recently told him that and his response to me was, that's why nobody likes you.
Beatrice Adler-Bolton 24:00
Right, because I mean, the situation is so untenable that it's basically put people like you in the position of being the bad guy right of enforcing and trying to make recommendations when you have the norm enforcers, like David Leonhardt, who, like, you know, they'll put out like, the newsletter saying, like, oh, you know, mask mandates don't work and like children are, are totally fine. And you sort of have this, this immense pressure, right? That's like taking away I think all this extra energy, and it takes up I think, a lot of energy to fight back. And there isn't a lot of feeling of sort of solidarity from people. Because I think when you sort of try and advocate for this stuff, you you often end up with people, I think asking you for, for a kind of list of like what is safe and what is not. Proof that people actually just sort of can't provide. I mean, what what kinds of information do you think we're going to need in the way that we needed certain talking points with COVID and kids to be able to fight this narrative on outdoor transmission?
Dr. Theresa Chapple 24:57
You know, something else came up to mind while you're talking, so I'm going to answer this first and then work my way to your question. But in like the summer of 2020, there were researchers who created like, a COVID Dow, like, this is very unsafe behavior. This is safer things that you could be doing. And I think that right now, people, especially vaccinated people, and fully, fully up to date on their vaccines, just lump everything together. And they have decided that the vaccine is the safest thing that they could have done. And so that means that every other activity they do has equal weight. And one of the things that I think is really a missed opportunity is for us to be talking about the different strains of the virus and the disease, and the role that the vaccine plays in fighting the virus or the disease. When I talk to people about it, and really talk about it in terms of like HIV being the virus and AIDS being the disease, and SARS-CoV-2 being the virus and COVID being the disease, I get people to understand and see the difference between, you know, what the vaccine does and how the vaccine works. And then still, their need to remain safe. I think another message that people are missing is that you don't need to do all the high risk activities you want to do all at the same time. Right. So I have a funeral to go to this weekend. And it's an outdoor funeral. And so we've been talking, I have been talking to my family about making sure that we don't do high risk activities in the week leading up to it, making sure that we're going to test once we all come so that when we get together at this outdoor event where we will all be masked, we won't be putting other family members at risk. Right? But how many other families are having this conversation that don't have an epidemiologist embedded in their families? Right?
Beatrice Adler-Bolton 27:06
Right. None. Yeah.
Dr. Theresa Chapple 27:08
People are coming around their elderly family members at a funeral, they're hugging them. And now we have the spread that is now more dangerous for one subset of your family members. And so I just think in terms of like everything that's missing, like that, that's what's all missing.
Beatrice Adler-Bolton 27:26
Right. And that's completely absent from the sort of structural perspective that people are offered on COVID. First of all, I'm sorry for your loss. But I'm impressed that you're you're sort of able to talk your family into being on top of this. I mean, I'm sure having the position of being the epidemiologist in the family makes that a little bit easier. Obviously, it's your, your job. And so people trust you, but I think a lot of people feel that when they try and like communicate these things to their family members, their family members have these messages that are from, you know, sometimes from the CDC, sometimes from the federal government, but sometimes just from like completely other sources, right, which are external, you know, maybe through like, their, their workplace policies, right? Like, oh, well, I work in a healthcare facility, and I don't have to wear an n95 mask there. Right. And so these, there are these sort of structural components, which I think make it really difficult for people to try and have these conversations when there is this bias towards kind of normality, where you have this kind of like social pressure to minimize, right? I mean, what do you I mean, do you experience like talking to people who maybe like, in the course of investigations, who were like, also like, put in positions where like, they're not comfortable with how they got infected, because I know a lot of people like are choosing to do these activities. But at the same time, there's like, so many people that are also like, pressured into it, whether by like work, or you know, by family members or an obligation of some other kind.
Dr. Theresa Chapple 28:53
I have heard so many people express anger at the fact that they have managed to stay COVID negative for 24 almost 26 months. And yet, a policy change has forced them into an environment that is less protective than the one that they've created for themselves for the last two plus years. And then they end up either exposed to COVID immediately, or testing positive for COVID. The number of people who have really just expressed their anger at that has been extremely high and yet they're treated as if they're the ones that are wrong. I actually heard someone say, like, what are you waiting for to catch COVID? Like, you're gonna catch it. What are you waiting for? When? Why are you upset that you have it right? Because people have now just accepted that this is a fact of life that you're going to catch COVID. But then they also on the other side, say that COVID is like the flu, but I have never had a flu season where people have just said, what are you waiting on? Go ahead and catch the flu. right?
Beatrice Adler-Bolton 30:03
Right.
Dr. Theresa Chapple 30:03
Everybody's going to catch it. No, this is, it's weird to have this duality of thinking that people have just accepted both of these really odd things to be equally true.
Beatrice Adler-Bolton 30:16
Right? Because I mean, really the way that you sort of get sick I mean, I think you alluded to this when you were talking about the using like HIV seroconverting to AIDS as a as a metaphor to help people understand sort of how you go from a having SARS-CoV-2 in your body to having COVID 19 the disease, right, because I think people misunderstand how viruses move through the world. I mean, viruses like we ascribe this kind of like anthropomorphized framework to them, where we say we're like battling the virus, it's a war against this virus, it's a war against COVID-19, we have to learn to live with COVID-19, as if it's some sort of like foreign invader, right? And not only does this have like a long political history, like tied in with imperialism and xenophobia, like, it also gives us a mentality about the virus that makes us think that like, there is something out there in the air for us to sort of capture and battle with, right? But the fact of the matter is, is that these are sort of inert things that are floating around in the air, they're not like out in the air trying to target people, right, or like, looking for all the vulnerable people in the crowd, it's passing through your body at all times, right, it's just a matter of how much virus is in you, and where your immune system is at, at that particular point, whether or not you're going to be, you know, cross over the border between just having SARS-CoV-2 virus in your body, and having those replicate enough for them to really produce like a COVID infection.
Dr. Theresa Chapple 31:47
I think one of the things that has made it hard for people is that COVID has been around for two plus years. And especially the people who have not ended up testing positive for COVID in this time, is that they start to believe that, you know, I'm never gonna get COVID or I have this special repellent around me that repels COVID. When one of the things that I think the CDC did really well, with the change from Alpha to Delta, was talk about the fact that Delta was a, this is a new game, this is a new beast, or however they described it, letting people know that this one is much different than what we were dealing with with Alpha, it spreads faster. But then what they did was tell you to use the same tools that we had for Alpha. And so that really kind of messed up the messaging. And now here we are, with, you know, all these Omicron sub-variants. And these are spreading way faster. And yet, we haven't came out with new messaging about how it spreads, and about how, you know, you can now be more at risk for catching it than you were with the earlier variants that we had. And I think that's one of the core messages that have been missing throughout. Because I have, I have people in my personal life, who have said, I haven't caught it, yet, I'm not going to catch it, I just, you know, have this super immune system that's going to allow me to stay safe from this. And they're not understanding that the virus is changing, the virus is doing exactly what viruses are supposed to do. But people don't realize that the virus's job is to always outsmart us, so that it can continue to replicate, right? And so I think that's kind of some of the messaging that really needs to find its way out there. And that we need to stop saying that we have the tools to fight it, we need to say that these are some things that we can do. And as the virus continues to get smarter, we have to continue to get smarter, as the virus continues to get better at being infectious, we have to, you know, rev up or change some of our approaches or things like that. And nowhere in our messaging do we talk about how we need to adapt as the virus adapts.
Beatrice Adler-Bolton 34:24
Right. I mean, that's virtually absent from the equation now. I think a lot of people bought into the idea that you know, the vaccine lowered your personal risk enough that they've kind of conflated like personal risk of severe disease and illness with your ability to to like be passing on a virus like case into your community, right? Because I think that's that's one of the big problems is that when people hear like, oh, you know, you you're vaccinated, you can be like you're fully vaccinated, you can be relaxed now, go to events, take your mask off, like go to Disneyworld, whatever, you know, people, part of what they're basing, like, their calculations on is not sort of like, I think, an understanding of like how viruses move through the community, right? Like if one, you know, if you've got these kind of like close contacts, right that you're, you're around and you think, oh, well, maybe they're all healthy, and it's fine. Like, I just don't think people are thinking sort of beyond these immediate interactions to the interactions that those people have, and so on and so forth. Because I don't think that they're, you know, as you said early on, it's kind of like, this is a this is a failure of like science education. And this is a failure of our sort of society to have prepared systems that are ready to deal with anything other than a like fully sort of commodified consumer approach to public health. Because what we have now is we're trying to sort of treat a disease that's in the air as if, you know, you can control it, sort of, by exception and by rule, right? And that's, that's fundamentally not actually how this works, we sort of have to approach things, I think, with the perspective of sort of knowing, okay, like the virus is in the air, it moves in the air, when it's hot out, you know, the virus, like, maybe the virus will die more, but like, whether the virus is like, in the air in abundance, or it's in the air in only a little amount, like it doesn't matter, that could be the moment that you like, have enough in you to get sick anyways. And that idea is like considered alarmist. I mean, it's considered alarmist, but it's just a description of actually how getting sick works.
Dr. Theresa Chapple 36:31
Yes, I, all of this is so weird to me, as a person who has studied public health for 22 years now. I think one of the oddest things that has happened throughout this pandemic is us talking about it in terms of individual responsibility and individual health. This is a, it's a communicable disease. And the whole point of a communicable disease means that someone else has to give it to you, right? So even if I'm as responsible as I could possibly be for my own health, I'm getting it through another vector, I'm getting it through another way that I can't control. And so I just find this, the fact that so many people are okay, taking an individual approach and sharing that with others, as the way that we should be handling this, I find this to be extremely odd, because this is not public health. And I mention that all the time, when people tell me or ask me why I'm not supporting an individualistic approach to this, I make it clear that I'm not a medical doctor. Medical doctors deal with individual health one on one, I deal with public health, and it is my job to make sure that the public is healthy, and that I'm stopping transmission at a population level. And so I make it clear all the time. I'm not qualified to do one on one.
Beatrice Adler-Bolton 38:01
Right. I mean, can you, in your professional opinion as someone who studies health at the population level, can you stop covid with personal responsibility?
Dr. Theresa Chapple 38:13
Impossible.
Beatrice Adler-Bolton 38:14
I mean, I can't imagine a future where that's possible. And I think one of the things that we keep trying to see from people is like: 'Oh well we just need to like commercialise this. Oh it's just time for like covid to sort of enter the private market.' And, you know, I think for people who, you know, work in public health, who study health, who study sort of the economy of health as well, it's terrifying to think about, you know, what's going to happen when you have the dynamics of COVID and the kind of disease that COVID is. When you have that meet our systems right now that already perpetuate just disinvestment from communities that need access to healthcare. When you have systems that basically ration care according to ability to pay. You know, there are already like tremendous waits for an appointment if you're, like if you're a Medicaid patient, right? Like as this sort of state of emergency ends and I think that's very much something that people right now are advocating for more, moreso than they... I know this is like something that happens over and over like someone declares the end of the pandemic like every day, but, you know, I think as we enter summer and because of this myth of like outdoor transmission doesn't exist and doesn't happen we kind of are in this opportunity where the fight for the end is going to be really hard in the coming months.
Dr. Theresa Chapple 39:33
And add to that people not testing and people taking at home tests and not reporting. It's really going to be the challenge of the summer as to really being able to identify where we are at this stage in the pandemic. And I try and be clear to people all the time, like this... I get asked often when is the pandemic going to end? And I remind people that I'm not the one that called it the pandemic and I'm not the one who can end the pandemic. Like that is literally the job of the WHO. And if you hear anybody else say that the pandemic has ended and they are not the spokesperson for the WHO they are not the source that you should be listening to on if the pandemic has ended or not.
Beatrice Adler-Bolton 40:21
No, I mean, I think, you know, it's, it's a fight that we're looking at right now, where you have people sort of just like trying to get out of, I think, trying to get out of structural critique, right, and trying to get out of these big solutions, because you see this like horizon of of getting these things funded, like, as increasingly smaller. And what I think worries me so much is that, you know, as you're saying, like, there, there's lots of home testing, there is no pathway for reporting home test positives, we are slowly losing the tools that people like you were using on the ground, doing applied work, also to even communicate and track these, you know, outbreaks as they occur in communities. And right now, I mean, it's basically the United States is just one big outbreak again. And unfortunately, we've been in this position like too many times, but, do you worry that some of the tools that you need to fight COVID are not going to be there, you know, come this time next year?
Dr. Theresa Chapple 41:17
Totally. Even this time, like, what I have personally seen, is the same, you know, impacts of COVID this spring, it's reminiscent of the impacts of COVID from the winter surge. But our numbers are not the same as from the winter surge. And it's clear to me that it's a... it's the fact that in the winter surge, home tests weren't available. And now home tests are abundant. But if I go to the store, and the store is closed for COVID, then I know that we're experiencing a surge. And, you know, airlines are canceling hundreds of flights each day. It's because we're in a COVID surge, right. And these are the things that just aren't what, what, instead, we get are COVID case counts in looking at that nice, you know, peak that we see, and comparing our peak from May and June to our peak from January of this year, and saying the peaks aren't the same. But without talking about the fact that there are differences in reporting now that we that we didn't have. And so these two peaks aren't comparable, we're not having that conversation. We're also going into this phase where now we're watching the hospitalization rates as a result of the surge that we were just in. And we have lost over a million people already. So now we're going back to those same communities, and attacking those same communities with the same virus. And then seeing how many more people we can lose each time and how many more people which end up hospitalized. And I think that this is another kind of profile that needs to be drawn, and that we need to be talking about the fact that our number of people who are fully vaccinated and fully boosted, who are now hospitalized, has increased this peak, this.. this surge compared to the surges that we've had before, because our picture of who's vulnerable has changed each time that we are entering these surges.
Beatrice Adler-Bolton 43:24
No, I think that's a really good point. I mean, part of what I think is the problem is that we're in this framework where all of our approaches to the pandemic are overly simplistic, right, I mean, this kind of, this kind of discussion that we're having now is not something that is at all easily accessible to people, it's not something that's being communicated, you don't have the kind of work and labor going into, like talking to people about these things that you you need in order to give people the ability to actually sort of understand, what we have is this kind of risk assessment, you know, data driven risk assessment framework that that sort of gives people a score and uses averages and numbers to try and sort of almost bully people into taking the approach of using as little protection as possible as if it's like a bad thing to like, accidentally, maybe over prepare. And it's almost like the kind of attitude that people are being talked out of is framed as like, Oh, this is like a try-hard attitude or something. Oh, you're just like a sort of do goody who's like trying to do everything you can for COVID. And just because I don't do that doesn't mean that I don't care about vulnerable people. But like, you know, you were talking about having these conversations with people in your family. If you have someone in your family who was like giving you that back. If you were saying you know, here's what we need to do before an event because the state has abandoned us, because COVID is everywhere. You need to reduce your high risk activities for you know, a week to 10 days. We need to follow these protocols, we need to be masking even when outside. You know, and if they come back to you with this kind of well, you know, screw you like this is just like, try-hard do goodism, and I'm not, this isn't realistic, and what are you going to make me do this forever? Like, what would you say to that person?
Dr. Theresa Chapple 45:13
I run into those people all the time, my children mask at the playground, and I get looks from people. At the playground recently, someone told my six year old, you don't have to wear a mask outside. And so my six year old started to take off her mask. And I said to my six year old, mommy would like for you to wear a mask, and mommy would like for you to remind people that you can protect yourself in the way that you feel is best, and that your mask protects you. And your mask protects them as well. Right? So I really kind of take these as educational moments, and really try and show people that, okay, let's talk about what is the harm in adding this layer of mitigation. Right? And if there is no harm to wearing a mask outdoors, then let's do it. Let's add the layer of mitigation. If we're driving a car, when I was young, I used to sit on my mom's lap in the front seat of the car. We no longer do that. We have added multiple layers of mitigation that make the way that I used to ride the car not something that my my kids will ever experience, right? But no one will ever say that because you're wearing your seatbelt, you should cut off all your airbags, because it's not necessary, you already have protection, right? No, we want our seatbelts, we want all our airbags, we want our cars to be, you know, crash tested, we want sideview mirrors that beep and blink at us. We want everything, so that we can be as protected as possible in the car. But if I take that same thing and say, well, let's make sure that we're as protected as possible from COVID. Now, all of a sudden, there's something wrong with me. I'm the alarmist here. And this is just the design. I've mentioned before, that I've been telling people that, you know, you should wear a mask, and people would come back to me and say, cloth masks don't work. And so I would say well, why would you assume I'm talking about a cloth mask? Like why wouldn't I be talking about a high quality mask that works, right? Like, whenever I tell people that they should wear a condom, nobody comes back to me and says a sheepskin condom doesn't work. We just assume that we're talking about the highest quality condoms that you can buy these days, right? So I feel like just the where people are coming from in these conversations, they're, they're coming from a place of COVID fatigue, they're coming from a place of just being over it, from having to learn and know too many different things over these last two and a half years. And from a place of having survived. The hardest people that I've talked to about COVID and their behaviors are people who had mild cases of COVID. Those are the people who are like, I've had it, it was nothing. You're making a big deal over something just for the fun of it. I don't know why they think I'm making a big deal of it. But those are the hardest people to talk to because they have had their own personal experiences with it. And they just don't believe that there's an alternative experience that people have had or that people are going through right now. And so I don't know, the best way to reach that group. But I would love to hear how others are.
Beatrice Adler-Bolton 48:39
No, I mean, I think it's a difficult question. And it's.. it's, I think it's refreshing to hear an expert say that they don't know. I mean, that's something that you frankly don't hear often enough. Right? I mean, that's part of the problem that we have going on right now is that people are taking uncertain information and running with it. I mean, I think the the sort of landscape that we're looking at right now, going into COVID, COVID is not going anywhere, we're going to have to, you know, continue to organize and continue to sort of push and do approaches to education and sort of public messaging that are not being done in in ways that we shouldn't have to. Right? And obviously, like part of that is trying to find ways to talk through like what what is actually sort of going on? Where.. what is the sort of counter narrative that like could could be happening? Is there other... any other messaging that you would sort of want to like sort of give a corrective frame to that... that we didn't get a chance to touch on? Because I feel like that's very much sort of the theme here is like, we're touching on all of the things that like should be common sense. But, you know, absent, and maybe absent like the sort of landscape of elite capture of expertise, I don't know, you know, who knows this this could have been very different in a different political economy. But in the sort of landscape that we are now, you know, is there anything that we didn't touch on that, that you wanted to sort of talk about?
Dr. Theresa Chapple 50:05
I think that one of the things I want people to know is that it is impossible for you to assess your own risk. You don't know what the person beside you has done, unless you live with them or are around them all the time. You don't know about the person on the airplane, you don't know how many air exchanges your office building has. There, it is impossible for you to assess your own risk. And if you can't assess your own risk, then your health is not in your hands. We live in a society where our health are dependent on the health of others. And so that is the message that people need to hear and, and there was a thread on Twitter, started by an epidemiologist that said: This is what I got wrong in the pandemic. And then all these other epidemiologists came on and talked about, you know, the piece that they got wrong. And for me, the piece that I got wrong was that I thought that the pandemic would teach people that we are interconnected, that our health, that our lives are interconnected, and that my health depends on yours. And your health depends on mine. I really felt like a, you know, contagious airborne pandemic would teach us that, but instead it's taught us that individualism is the way to go. And that survival of the fittest is, you know, what we need to be focused on once again.
Beatrice Adler-Bolton 51:32
Yeah, and I mean, it's funny, because that's the thing I got wrong, as well, as I thought that this was going to be a wake up call to like, give people an understanding of sort of post viral illness. Because even early on when you started getting those first reports of long COVID In the first six months, and it was like, this sounds like it's going to be a sort of polio generation situation, right? Maybe this will have like the kind of requisite effects politically. But I think the thing that I was wrong about, right, is that I assumed that those political effects were intrinsic to the sort of violence that was happening. And what's actually going on is that, like, if we want those political effects, like we have to make them, we have to force the political will, because right now, yes, what's stacked against us is, like, formidable. But, you know, we have, like, the unfortunate and very obvious truth on our side, which is that COVID is airborne, and not going anywhere.
Dr. Theresa Chapple 52:29
And one thing I keep reminding people who are upset about mitigations, and upset that, you know, they have to do something, is that the problem is not with the mitigations. The problem is the fact that we have this contagious virus that's out here, right? Like, we need to be trying to figure out how to, you know, stop the spread of the virus and not take away all mitigations because we're mad at the fact that we have to wear a mask and it's, you know, a little sweaty in the summer. So yeah, I think helping people kind of reframe and see this as, yeah, your child's classroom closed, because of COVID cases. The issue is not the fact that the classroom closed. The issue is the fact that there were enough COVID cases that caused the whole classroom to close, right? Trying to reframe the problem for people has been a really hard task.
Beatrice Adler-Bolton 53:27
Well, I mean, it's, it is a lot of work, it requires a lot of energy and sort of sustained commitment. And that's something that's difficult, you know? But, I think it's... it's funny, one of the things that I was just thinking of when you were talking earlier was this kind of... the kind of like approach to the pandemic early on, right? The approach to not knowing, I think, was valuable, and I appreciate the way that you sort of framed that, not necessarily as a... as an approach to not knowing, which is kind of like how it was framed early on, like, oh, we need caution, because we don't know. Not knowing is kind of just a normal condition of science, right? I mean, it's controlling for what you know. We know that masks work, and are the kind of intervention that if were distributed and in an equitable way directly to people, you know, would be a tremendous intervention. And these are the kinds of like ways that we have to be thinking and like willing to make demands and I think, right now, it's just like, not even the, you know, this sort of whole position of like having different opinions on COVID. Like, in and of itself, that's also redounded into the individualistic frame when it's like, oh, no, you're just paranoid. Oh, you're just crazy. You're hysterical. You're, you know, being an alarmist like, no, like, we're making like system critique. Like we're demanding things. We're not being crazy.
Dr. Theresa Chapple 54:53
Yeah. The last thing I want to say is that I really wish I was old enough to know how things were done with the HIV epidemic. And how we got people to know and understand like, yes, you're gonna wear condoms, anytime you have, you know, a sexual encounter that is... without... you know, that's not in a steady stable relationship, right? Like that is something that was a message that had to come out and had to have people you know, learn and change their attitudes, and their practices and buy something and do something each and every time, right? And now, I don't think you can find, you know, a 20 something year old who doesn't know that message, and it just hasn't been embedded as a part of their life, right? So when people ask me and say stuff, like you want us to wear masks forever. No I don't. But if we have to, there's already been things that we do forever as a result of viruses that we don't want to catch, right? So this wouldn't be the first time, if we had to wear masks forever, this wouldn't be the first time that we had to make a change to our lives, to our comfort and to the things that we're used to, in order to stay alive, right? All humans, all humans, we're only here because we adapted to things we were able to stay alive. So I think I really would love to know kind of how that messaging went from this being something odd and awkward in how you have those conversations to something that now you know, everybody just knows to do. And I would love to learn from that in terms of what we could do for COVID in behavior changes here.
Beatrice Adler-Bolton 56:39
Yeah, I think there are a lot of lessons to learn. Because I mean, one of the things that is so important is that we have sort of tremendous reframes that we have to make, and this is going to be a long term collective effort. And it's going to require a lot of creative work and a lot of diligent and patient struggle. And I think that's something that we absolutely can look to people who have been working on that for decades now with HIV AIDS to try and figure out some, some shortcuts to getting started because it's, you know, it's... I think it's a it's a fight worth having. You know, when people ask me now, are you... will you want me to mask forever? I said, I say if it's necessary, you know, yeah. And I'm willing to be honest and say that, right, you know, if it's necessary, yeah, fine. Like, you want to make it not necessary, then show up. You know, like, there's gonna be some cooperation required and it's gonna start, you know, not with arguing with me, but with like arguing with people who are actually in a position to, you know, make sure that everyone gets the masks that they need to wear them forever, because Lord knows, we should not have to fucking pay for them out of our pockets.
Dr. Theresa Chapple 57:55
Right.
Beatrice Adler-Bolton 57:56
Well, Dr. Chapple, thank you so much for taking the time. It's been a real pleasure to talk to you. And if you want to follow Dr. Chapple, she is @Theresa_Chapple on Twitter. Dr. Chapple, thank you so much again for coming on today. It's been a pleasure.
Dr. Theresa Chapple 58:12
Not a problem. I enjoyed every moment of it. Thank you.
Beatrice Adler-Bolton 58:15
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Transcript by Scott McKenzie