One Year Later

Guest writer, Olivia Hobson, is a third year environmental journalism student at Western Washington University. She moved to Bellingham from Colorado three years ago, and writes about environmental and scientific research, community experience and social change.

- - - - -

What we remember

The cluster of pneumonia-like cases appeared in Wuhan, China, on Dec. 31, 2019. A novel coronavirus was identified, and the ongoing identification and spread of the disease in China began to raise flags in the global health community. As the one-year anniversary of those first COVID-19 cases approaches, what do we remember? What have we learned, and what do we miss?

Unidentified illnesses are more common than some people might believe, according to Steve Bennett, an epidemiologist and professor of public health at Western Washington University. “They are not rare. Usually they tend to be pretty self-limiting. Within the infectious disease and public health community, we’ve all known that something was coming down the pipe at some point. But it was a game of roulette as to which disease would be the one that caught on.”

Bennett has been helping inform Whatcom County’s response to COVID-19. But he admitted that early on, he was actually wrong about his pandemic predictions. He had not anticipated that the respiratory illness in Wuhan would be that “something” coming down the pipe. After it started infecting hundreds of people and transgressed national boundaries, however, he realized that it was going to get serious.

Despite his research background and the anticipation of a public health event in his field, the speed with which COVID-19 changed the world still surprised him. “You can expect something to happen and you can know something’s coming and still be surprised when it does.”

Doctor Sudhakar Karlapudi is the chief medical officer and the patient safety officer for the three hospitals in San Juan, Skagit and Whatcom counties that make up the Northwest network of PeaceHealth. He began to understand that COVID-19 would not be a self-isolating incident on January 21 when PeaceHealth was creating its incident command team.

According to Karlapudi, in the early months of the pandemic, physicians were challenged with the lack of scientific, peer-reviewed literature on COVID-19. “In many cases, most of the information was coming through without the same rigor of scientific study because we didn’t have the time. We were getting a lot of medical information from the news and non-peer reviewed journals.” Another challenge for physicians while trying to help patients was the difficulty of communicating information that was just developing or completely unknown. “I think every physician who has taken COVID-19 patients has a unique story of how difficult it was to explain something that nobody knew anything about.”

The COVID-19 pandemic is something that has changed the world for the foreseeable future. But as momentous and historic an occasion that the first outbreak was and would become, it did not carry the weight of a world-changing event. At least, not then.

A month and a half later, things would start to look very different. Cases had spread to many other countries, including the United States. Washington state was home to the first known U.S. outbreak of the disease, named COVID-19 by the World Health Organization on Feb. 11. The first U.S. death was reported on Feb. 29. It was declared a pandemic on March 11.

Jay Inslee, Washington state’s governor, wrote that a stronger initial federal response would have averted some of the challenges the pandemic has presented. Despite this, Washington state has learned much, and open channels of communication between government officials in California, Oregon and Washington state have aided in a strong state response. “This pandemic has been unlike anything I’ve tackled in my first two terms,” Inslee wrote in a statement. “The most challenging part is just knowing that people are suffering right now, whether it’s from the virus or from the economic impact of the pandemic.”

The second week of March, students on campus at Western Washington University were wary. In an environmental studies class the week before finals, Dr. Mark Neff, a professor in Huxley college, was leaning against the table at the front of the room, arms crossed over his brown flannel shirt, waiting for the last stragglers to trickle in. Someone mentioned they’d heard a rumor that finals would be moving online. He said he didn’t know much more than the students, but he did have a word of warning: “Folks, this is going to get rough. Buckle in.”

On March 11, Western moved all finals online, and by March 19 decided to conduct classes remotely for the spring quarter. Now, eight months later, Neff attributes his foresight to his paranoia of a disruptive event in a fragile public health system that younger generations seem to dismiss. “A lot of folks think that we’ve solved these big scale health problems. Through modern medicine, through vaccines, that a pandemic is a thing of the past,” Neff said. “I think I had an early conviction that we’re not immune to [public health events].”

Evan Bush, a Seattle Times reporter on the COVID-19 beat, was alone in the newsroom one Sunday evening in January when a University of Washington student needed access to testing after possible exposure while visiting China over winter break. He remembers having to work with an editor to write up a story; that evening was the first time he had a real feeling that the illness would be coming to the U.S. Before that, it hadn’t seemed quite so certain. “I think I read the [early] stories, but honestly I’m not 100% sure. I know I read the headlines,” Bush said. “I think my general feeling as a reporter was, ‘Well, it’s not here yet. We don’t understand the nature of this. When it gets here, we’ll deal with it.’ And that was pretty naïve, I think.”

What we had to learn

The U.S. met the challenge of the ever-changing nature of the pandemic with mixed success, according to WWU’s epidemiologist Bennett. Masks, for example, had an array of mixed messaging on their efficacy and necessity. While researchers were able to conduct research, learn from their mistakes and change their recommendations about wearing masks, communicating why that change happened was one of their short fallings, Bennett said.

Messaging from the national level also played a tremendous role in creating a mixed U.S. success.

“If you have a central messenger who is sowing discord and confusion, and then you have public health professionals who are trying to take more aggressive measures to stop it, that causes an understandable frustration.” - Steve Bennett

Public health officials face a constant battle. Stringent health measures, like wearing masks, social distancing and limiting exposure, help keep case numbers low. But when case numbers are low, the need for those stringent health measures feels less extreme, and there’s pushback against them, Bennett said. Relaxing measures results in an increase in cases, and the cycle starts over.

As the situation progressed, reporters without scientific or medical reporting backgrounds were “thrown into the deep end,” according to Times reporter Bush. Having to learn how to report on quickly-changing science in real time was a rewarding, if not unsettling, experience. “Seeing the whole staff engaged on this single effort was really fascinating and stressful and terrifying. It’s really, really hard to find the right way to convey information and uncertainty around information. The journalism community is figuring out how to deal with science in motion all at once.”

PeaceHealth’s Karlapudi believes the medical community could always do better when it comes to communicating scientific facts to the broader community. Combating the spread of misinformation has posed a significant, frustrating challenge. “Communicating to the best of our ability, keeping to the facts, trying to be neutral with what we say… that’s what we have taken as an approach.”

“But has it been frustrating? Oh my God, yes.” - Dr. Sudhakar Karlapudi

Constantly adapting to a shifting situation is difficult on everyone. As a Huxley educator, Neff has made changes to his instruction similar to others within his circles. He’s tried to cut his assignment load by 10% and understands that different life circumstances for his students require extra flexibility. Because students are still paying almost full tuition, he’s trying to strike the balance between cutting content and providing the education students are paying for. “You add all of the chaos of COVID - whether it’s additional responsibilities or just the emotional burden of living through these times - I’ve got to imagine those time crunches are even worse,” he said. “[Other professors I’ve talked to are] trying to do what I’m trying to do, which is cut back, add flexibility, but try to maintain content.”

Mark Neff acknowledges students struggle with their worlkoad balance. A full time course load is a larger time commitment than a full time job, even during normal times.

Young people like college students have been framed as threats during the pandemic rather than as a threatened population, says WWU’s Bennett. Even though their lifestyles in the U.S. have always included roommates, high-interaction jobs, and dating practices, they were told to stop living in the way they had been, but weren’t given any strategies for doing that.

Messaging about prevention struggled to address how people should behave if they must interact with people outside their household, Bennett said. Because students don’t live with families, isolation and loneliness became high concerns, and young people had to navigate difficult decisions without guidelines.“Even recently, we were telling people just not to see each other, but that ignores the fact that people are going to see each other. It’s kind of like doing an abstinence-only sex ed.,” Bennett said. “Our communication was very, ‘Don’t Do It,’ rather than, ‘You shouldn’t do it, but if you do, here’s how you do it safely.’”

In general, messaging about transmission prevention was framed in an “all or nothing” way, where people were either perfect or failures, Bennett said. “That kind of messaging is terrible. If people are told that they’re the problem, they don’t get better. They functionally flip you off at that point, and you’ve lost bringing people in.”

What we miss

COVID-19 has reduced connection. Celebration. Closeness. Everyone is missing something, and that only gets harder the longer it goes on, Bennett said.

As an epidemiologist, Bennett has been working with WWU’s COVID In Real Life campaign to help educate people on navigating college lifestyles during a pandemic. He contends that creating messaging that acknowledges these difficult changes to every day life is important to create safer, more realistic guidelines.

“We’re asking people to do a health behavior that gets harder the longer you do it, which is really different. Normally in public health we ask people to do behaviors that become habitual. We don’t naturally, habitually become isolated.” - Steve Bennett

As a physician, treating patients has undergone many changes, some good and some bad. The quick transition to telemedicine has been a big improvement, according to PeaceHealth’s Karlapudi, but in-person care is dramatically different. “Most of us, when we walk into a room, we’re able to talk to our patients face to face. In this world, no one has been able to do that. When we go into COVID units, we’re wearing these [protective] hoods. You kind of feel like you’re an astronaut entering a room.”

Bush misses chatting in the newsroom and witnessing colleagues make connections between stories, something that just doesn’t happen over a Zoom call. The future of news coverage, with large budget cuts and a loss of small newsrooms, is going to be a changed industry, he said.

As a professor, Neff has observed and experienced the stress, struggle and disappointment of a remote learning environment. With two young children at home, he has had to adjust his own life routines, and knows that it is a shared experience. Ultimately, he acknowledges online learning isn’t ideal.

“Many of us are hanging on by a bare thread. This is true for everyone - students, staff, faculty. It’s been a triage in survival mode as much as it’s been active adaptation to changing circumstances. There’s a lot that doesn’t work terribly well in the online format. Any inequalities in terms of student performance that existed pre-pandemic are exacerbated.”

As a governor, Inslee has been proud of the way Washington state has worked with other states and partners to address the pandemic. He believes that by working together and being supportive of one another, we will reach the day when things can start to feel normal again. “The most rewarding aspect of this – the moment when we see fewer people sick from the virus, the moment we can lift all of our restrictions, the moment people can begin to feel normal again – that hasn’t come yet, but it is on its way,” Inslee wrote.

“We have to stay hopeful, healthy and supportive of one another until then. We will get through this.” - Jay Inslee

Whatcom County has done very well when it comes to wearing masks and social distancing, Karlapudi said. He is hopeful that as a society we will get COVID-19 under control. But going into a dramatically different holiday season, he has one reminder: “Do not travel for Christmas or New Year.”