In the five years since schools and businesses across the globe shut down in an effort to slow viral transmission during the COVID-19 pandemic, heated debate and reverberating impacts have changed the public health landscape. Becky Smith, a professor of epidemiology at the University of Illinois Urbana-Champaign, is an expert in public health policy. She talked with News Bureau biomedical sciences editor Liz Ahlberg Touchstone about what the 2020 shutdowns and the public responses to them have taught us about what works — and doesn’t work — in public health policy. Watch the video by Andy Savage.
The shutdowns were one of the biggest, most memorable aspects of public health measures undertaken in 2020-2021. Why were shutdowns used?
Shutdowns are something we never really want to do in epidemiology; we’re aiming for the least pain and the most gain. But when COVID-19 first arrived, we didn’t have a test, we didn’t have a vaccine, we didn’t even know for sure how it spread. It actually took quite a while for us to decide for sure how it was spreading. So the shutdowns were a way for us to find out a lot of that stuff and build up the infrastructure.
The idea of the shutdowns was, let’s all just pause, keep it from spreading too much, keep it from overwhelming our hospital systems, with the idea that we would then build up all the infrastructure to respond and get the research jump started to understand better how we can prevent spread without being so draconian.
Given the large and, in many cases, still ongoing impacts of the shutdowns on the economy, mental health, education and more, were the shutdowns worth it?
I think the shutdowns would have been worth it if we had used that time the way we were meant to. We did shutdowns, but we didn’t build the testing capacity. We didn’t build monitoring systems. The work to understand the transmission was not being done. It was just shut down, and then nothing. At least the shutdowns kept the hospitals from being overwhelmed. That was good, but really what we needed was a shutdown followed by a real rush of research — which is what happened on this campus, which was great, but we didn’t have that nationwide. And that’s what we really needed.
What did we learn about what works — and doesn’t work — in public health responses to infectious disease outbreaks?
I think one of the big things that we learned, especially on this campus, is that you can’t tech your way out of human problems. We have to consider the communication, outreach and human side of things, along with the technological responses. We needed more social scientists involved. The vaccine development was amazing, but, unfortunately, what they didn’t do at the same time was the work to understand how to get people to accept the vaccine. We ended up with a great vaccine that a whole chunk of the population wouldn’t accept.
What did emerging controversies about masks and vaccinations teach us about how people respond to health directives?
Some people say, “A lot of the backlash against masks and vaccines was because they were being forced into it.” I’m not sure that’s the case. I think it’s more that we didn’t communicate with people the reasons why.
We’re working under the old assumption that if we tell you something is safe, you’re going to do it. And now people really want to know why. Why am I doing it? So we need to be better about communicating.
Most of our messaging in public health has always been, “This protects the community.” We’ve learned that is not a sufficient argument for a lot of people these days. We need to understand what actually motivates people and how to explain — in terms and in ways that are not talking down to people, and speaking their language — what we’re asking them to do and why.
You also led the development of the K-12 SHIELD handbook, which helped schools in the state reopen after the shutdowns. What did you learn about our schools and their ability to handle infectious diseases?
We have learned a lot about schools and how to respond to a public health crisis in schools. We have learned so much, in fact, that we’re writing a book, and it should be out next fall.
We’ve talked to people from all across the country who were doing school response, and the biggest thing we’ve learned is that relationships are essential. You have to have trust, and you have to have a communication pipeline between the schools, public health and the community — and that has to be built ahead of time, because if you’re trying to build it in the middle of a crisis, it will be much harder.
Would I recommend shutting schools again? Sometimes shutting schools is necessary if the community is having an outbreak right then. But one thing that we found was that in schools that had testing and masks, the transmission was not being driven in the school; it was being driven in the community. So you don’t have to shut schools unless there’s an ongoing outbreak right then. If you have the infrastructure in place, if you have the policies around masks, if you have the testing capabilities, schools can stay open. It’s great that we know that we can do that now, because nobody wants to shut schools. We want to keep the schools open, and we can do that safely. We know that now; we just need the infrastructure and policy support.
