GRAND FORKS — Since the spring of 2020, the spotlight on leaders in the public health field has been more intense than ever. And effective communications and regaining public’s trust have emerged as important issues to many working in this field.
“We are all changed in some way by the pandemic,” said Debbie Swanson, director of Grand Forks Public Health. “History will likely provide many clues to what we could have done better, but it has been difficult with the rapidly changing science around both the virus and the vaccine.
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Public health authorities were running a marathon the past two years and the virus kept moving the finish line. Mitigation efforts were frequently changing, and this led to some frustration understandably.”
“With the pandemic, there’s been greater awareness of public health and the work that public health does — for better or for worse — in some instances,” said Shawn McBride, epidemiologist with Grand Forks Public Health. “Public health has long suffered from the challenge of, when our job is to prevent things, sometimes our work is not noticed or not necessarily thought to be needed, because the problems we are solving are prevented from occurring.”
The pandemic was a public health emergency that “had to be addressed and was very present in everyone’s minds,” McBride said.
Public response
Swanson said she has been impressed with the overall response to COVID prevention measures in Grand Forks.
"It has placed us in a good position compared to other communities,” she said. “We have had high interest in testing, lower infection rates, hospitalization, and death than our peer communities in North Dakota — Fargo, Minot and Bismarck. Having a local dashboard has been instrumental in this success.”
Overall, Grand Forks County and the region “has done fairly well responding, balancing the challenges of preventing infection, while also still trying to retain those everyday functions,” McBride said. North Dakotans were not going to see everything shut down.
“The approaches were, I believe to be, measured and, when applied, they were effective — the mitigation and prevention measures,” he said. “So I think individually, or as we get down to a smaller level, it certainly varies. Some places certainly weathered the pandemic better than others and what we saw is that prevention and mitigation measures that were advocated for were effective, when they were used. I do feel that many people, in most respects, utilized some or all of those measures when needed.”
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Opposition to vaccine
The answer to why some are so opposed to getting vaccinated “is complex,” McBride said.
“Part of this has to do with the very difficult informational environment in which we find ourselves. Many people are not always receiving good, reliable information. They could be getting misleading information, or information that tended to manipulate their viewpoints for an alternative gain, things like that. Unfortunately we live in a very polarized environment right now — especially through media and communication — people are siloed right now. Communicating effectively has been a great challenge for medical providers, public health. There’s a lot of noise out there that people are listening to. This isn’t actually all that of a new phenomenon.”
For years, McBride has been observing science skepticism and anti-vaccination groups, he said. “A lot of the features from those groups or those information sources, some of the things that they do were put into overdrive when it came to the pandemic and pandemic-related information and vaccination.”
“People do have concerns and, whether those are founded in reality or not is one thing, but they are real for those individuals,” he said, “and we have to work on addressing those concerns and gaining trust with people so that they understand that vaccination is the best way to prevent serious outcomes and the best way to ensure that we can move on from having to have COVID-19 in the forefront of our minds in our daily lives.”
“We always try to base our information we provide, our practices in sound evidence and scientific research, so people can be assured that, while science is maybe not necessarily always exactly right, science is a process of learning and understanding, and the scientific consensus at the moment is the best understanding we have at that moment,” McBride said. “So we try to use the best knowledge to communicate with people, and we do hope that that can give a sense of trust and reliability to people.
“We, as a whole, can look back on things that we think maybe could have been communicated better, other ways that we may have been more effective in communication,” he said. “Unfortunately, some of our shortcomings were (due to) the fact that, again, we live in a very polarized environment, and public health tries very hard not to wade into the politics of things. So a lot of times, our messaging or parts of it were utilized for political purposes, and those things kind of tainted public health messaging or information either for or against, one way or the other depending on the political messengers. That is a challenge we will continue to have."
Herd immunity
Earlier in the pandemic, the idea that reaching herd immunity, or a certain percentage level of immunity acquired by vaccination or natural immunity, could slow or halt the pandemic. But public health and medical professionals are beginning to think “a little differently about what herd immunity could do for us, McBride said.
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“Originally, there was hope that enough people were vaccinated quickly enough that we would be able to halt transmission of the virus and potentially eradicate it — basically it wouldn’t have anywhere to go, it wouldn’t replicate, and there wouldn’t be any more COVID-19.
“The virus has had different ideas,” he said. “And, as a whole, it was underestimated the degree to which it could spread globally and the challenges that we would be up against, ensuring that there were vaccinations for the rest of the world as well — as well as challenges in getting enough people to get the vaccine.”
Attaining herd immunity, to buffer a community from the serious consequences of infection, is going to be difficult to attain, he said. Herd immunity is determined, in part, by the effectiveness of the vaccines and the transmissibility of the variant
“We were very fortunate in getting quite effective vaccines,” he said. “Unfortunately, with the emergence of these variants — delta through omicron and now the omicron subvariant, BA2 — each one of those has been a step towards increased transmissibility and so with that you need greater coverage across the population from vaccination to stall or stop the spread of that virus through a population.”
Original study estimates suggested that 60% vaccination in a population would provide herd immunity, but each successive variant “has increased that number because of its increasing transmissibility,” he said. Because of that, the estimate is “likely to be 90% or upwards of coverage. I think there’s a realization that it’s going to be very, very challenging to reach that point.”
However, there is a potential bright side to all of this.
“With that increased transmissibility, more people have been unable to avoid infection if they are susceptible,” McBride said. “So a large number of people have already been infected with COVID-19 and one of the variants so far. The immunity gained from an infection does tend to transfer along to other variants, although the vaccination is better at that.
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“It’s likely that what we’re going to see is (due to) this immunity from natural infection or from vaccination … we won’t see large spikes or swings in cases, and those that are infected are going to be less likely to have severe outcomes; they will be protected from that by vaccination and from recovering from a previous infection.”
Other tools are also available to treat people who are susceptible for high risk for severe outcomes, such as “antivirals and monoclonal antibody therapy,” he said. “Those things are effective tools to treat people after infection.
“We’re probably going to be living in a world where COVID-19 is something that is kind of percolating around the world and we’ll see likely, similar to what we’ve seen, is seasonal swings in the numbers of cases but we won’t see the dramatic surges — barring, of course, a variant that changes all of that."
What the future may hold
Public health officials “are keeping our eye on the BA.2 subvariant of omicron and what is happening in Asia and Europe,” Swanson said. “The U.S. tends to follow what happens in the U.K. where cases are on an upward trend. How this impacts the U.S. will be influenced by waning vaccine protections and relaxed restrictions.
“Variants can move quickly and if we are not nimble with our response, it can be upon us before protections are in place. This does not mean lockdowns, but rather mitigation measures that allow us to continue most activities. Fortunately, vaccines provide good protection even with new variants to reduce severe disease requiring hospitalization and the need for ventilation.”
The future of the virus and its variants is ever-present in the minds of public health officials.
“In some sense, we can kind of predict what may happen based on what has already happened, although the impacts of it will be different,” McBride said.
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“Public health and health authorities, medical providers should be vigilant, because variants are likely to arise and the public needs to be aware that that is something that will occur. And then, depending on what we learn about the variant (that) may impact what steps are taken to reduce its impact.
“I don’t believe that emerging variants, moving forward, will have the kind of society-wide impacts that the original virus and then its subsequent variants have had (because) for the most part, many people — particularly in the U.S. and North Dakota — have some sense of immunity either through natural infection or through vaccination.
“And, while immunity does wane over time … there are some long-lasting benefits preventing severe outcomes. We’ll likely see that people are protected from the most serious outcomes through vaccination or having survived a natural infection, which we did not have previously when the virus first emerged and people were immunologically naive to the virus.”
Long-term study
Swanson said she and her colleagues in the field “will be studying this for a very long time,” noting that it would have been beneficial to engage social scientists from the start.
“It’s important to allow people to express their concern and really listen to them,” she said. In the past, “there was significant trust in health care providers and vaccines. That trust has been eroded – partially due to misinformation that has been amplified, less sense of the need to protect others, SARS CoV 2 being a novel virus, and the sense of urgency to get vaccinated to stop transmission. The latter led to a flood of messages about the benefits of the vaccine yet may not have addressed the fears of the younger generations.”
McBride urges people “not to forget those people who remain susceptible, (because of) their various medical conditions, who still see COVID-19 as a serious health risk to them and will continue to be a serious health risk to them, because perhaps their body doesn’t respond to vaccination or they’re immune-suppressed or various reasons.
“As we move on, and we put COVID-19 in the back of our minds, we won’t be going back to a time before COVID. We’ll have to still think about COVID-19 in the sense that, if we’re visiting high-risk people during a time when COVID cases are increased, we should consider testing before seeing them; we should consider masking when we’re around them to prevent avoidable exposures or infections.
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“Those are things that are going to change in our lives; we’re still going to have to think about COVID at times — but they’re going to be things we’ve outlined to do, to reduce that risk, and particularly to those people who are most vulnerable to serious outcomes. And I don’t want us to forget about that, because so many of them are still finding themselves concerned about going out to do things or being around some people.”
