COVID-19’s effects on vulnerable populations with social epidemiologist Amy Dailey

Amy Dailey: I mean, hopefully we’ll learn things like we shouldn’t wait for a pandemic to put these basic social protections in place.

President Bob Iuliano: We are embarking on something that’s never happened in the long history of this College. We have students waking up and beginning to be taught by our faculty where the students are located throughout the country, and indeed throughout the world. We truly are giving new meaning to being a global college. We regret of course the fact that we’re not together. We recognize that the sense of space and place is what really makes this a special place, but we know that our faculty is working really extraordinarily hard to bring about the best education that they can for our students. With us today is faculty member Amy Dailey, who will also demonstrate the strength of the Gettysburg community, so the breadth and the intensity of the intellectual interest that she has. She comes to us from the Health Sciences Department, and I’ll ask Amy to introduce herself by saying a word or two about the nature of her work and how it might bear on the current questions that we are thinking about as it relates to the coronavirus. I am of course Bob Iuliano, president of the College and your host for this podcast. Amy, welcome.

Amy Dailey: Thank you. Yeah, so I’m an epidemiologist. So that word has become a household word now. So the word epidemic actually is quite simple. It just means more cases than we would expect in a population over a certain amount of time. So we track infectious diseases through surveillance systems to try to keep track of trends and what’s going on, and try to reduce incidents and mortality. We also do that for chronic disease. I’m a social epidemiologist, so I’m interested in social and societal factors that influence why people get disease and what complicates those factors for disease. So with infectious disease, right now with this particular epidemic there is an important role for social epidemiologists understanding how social networks work with spreading disease. I am more interested in the consequences of what’s happening right now in terms of how this is going to affect vulnerable populations in particular.

President Bob Iuliano: As a social epidemiologist, is this disease affecting different populations differently?

Amy Dailey: Well, we know for sure the obvious one is health care workers are going to take a huge hit here. And so, they’re at very high risk, and especially with the concerns around running out of personal protective equipment. So that’s the PPE that people keep talking about with masks and gowns. That is only going to continue to get worse. Certainly low wage earners are often at higher risk. So service workers are often facing more exposure to people in general so they’re at higher risk, and then they also have more financial risks involved in terms of not having those protections for paid sick leave and those kinds of things. A particular concern are people experiencing homelessness, so people in this community and others around the country are trying to find ways to make sure that homeless populations are not too close to each other. So, thinking about ways to find new housing for people who don’t have housing. Incarcerated individuals are at high risk. And then of course nursing homes. We’re seeing this rip through nursing homes pretty quickly when it makes it there. Other populations that are higher risk are those with chronic conditions, so people with chronic conditions are more likely to need hospitalization. And we know that low income populations are also a higher risk for chronic conditions, so that will amplify that relationship as well.

President Bob Iuliano: Well, what’s discouraging about that description is that a lot of those are structural realities that aren’t going to get fixed even if we wanted to over the course of the duration of this pandemic. And so that suggests that the problems are going to be severe for those populations and there aren’t ready answers. Is that a fair read?

Amy Dailey: Yeah, absolutely. And the long term implications are, if this extends weeks, if not months like some people are predicting. Yeah, it’s going to be a crisis on lots of different levels.

President Bob Iuliano: There’s a lot of talk about testing. Again, I’m not an epidemiologist so I’m out of my league here. I certainly get the logic of testing when you’re at the nascent stage of the disease. If you’re in New York City now, is testing important where the disease is so ubiquitous? How do you respond to the problem that New York has versus say Adams County in Pennsylvania?

Amy Dailey: Yeah, I mean it’s a good question. I mean, ideally we would have a lot more capacity for testing for lots of different reasons. I think that some people are saying we need to have even more testing in the hard-hit areas so that we have a better idea of what the actual community incidents is so that we can make better predictions and make better decisions. Eventually we’re likely to do some community level blood testing to see how many people have actually been exposed and recovered from the disease. I think that we’re seeing from South Korea and Germany that more testing allows us to identify those clusters, because we know that clusters of individuals are still, that’s how the infection is spreading. And the faster you can isolate, and quarantine people and know exactly where it is, the easier it is going to be to try to do something.

Amy Dailey: But yeah, I’m hearing stories. I’m reading reports every day that I think many, if not most, Americans who are experiencing some symptoms still don’t have access. And those questions about who gets access to testing are being made differently in different places. Some experts believe that it’s most important to get the most critically ill tested, and some experts think that it’s important to try to figure out some of the less severe or more mild cases so that we can try to stop the spread. But what’s clear is we don’t have testing capacity in this country.

President Bob Iuliano: I mean it’s easy to be a Monday morning quarterback, but it sounds like a lot of these questions should have been thought through, resolved and dealt with before we were in the throws of the crisis.

Amy Dailey: For sure.

President Bob Iuliano: Which is what people like you think about and help argue for. You and I were talking briefly about this before we started the podcast, but we’ve seen pictures of people on spring break all over the beaches in Florida. I just heard something in the New York Times this morning about a coronavirus party in Kentucky in which a participant has now been tested positively. What I understand about this is social distancing really does matter and there needs to be a critical mass of people who are doing this. So have you studied or do you have thoughts about, how do we get the skeptics or the people who believe they’re invulnerable to take seriously the collective responsibility that this seems to present to us?

Amy Dailey: I mean, it is interesting to see this wide spectrum of responses, from panic all the way to indifference. I think young people in particular are indifference of flu-like diseases because they perceive themselves as healthy and able to fight it. And that’s largely true, although some of the data’s really concerning about young people and the severity of this disease. I taught a class on pandemics, a first year seminar a couple of times, and I was always trying to convince them that flu or something like flu is going to be what gets us, and they were more interested in talking about Ebola.

President Bob Iuliano: If you’re taught it now, Amy, my guess is it would be well subscribed and they would believe you.

Amy Dailey: I know. I know. I think generally people are doing a good job of cooperating. I think there’s more and more social pressure to not be out and about. But one of the worries is that actually mandatory quarantines, and lockdowns and travel bans actually undermine public trust and amplify some of those fears and anxieties. So, I don’t know what the balance is. I think at the bare minimum we need to make sure that people have access to basic necessities like food, and medicine and sanitation supplies. Lots of people are making jokes about toilet paper right now, but I mean that’s really just a reflection of our anxieties. But communities are mobilizing, but it’s hard because we’re all told to stay at home. And so some of those community mobilizing efforts, we don’t know what to do because we’re used to going out and helping and being there, and we’re having to do that from afar. So I think people staying connected through social media and in ways like that are helping to convince people that this is important. And I think the longer this goes on, unfortunately we are going to see it get worse and people will take it more seriously.

President Bob Iuliano: On this campus, one of the things that built my spirits is watching the ways in which we’re already figuring out how to support one another virtually, and we see it from the students and the faculty. It’s very encouraging. Say more about what it looks like if this goes on into the fall, what are some of the pressures on the system that we should imagine, not at the College so much, at a societal level?

Amy Dailey: I mean, the things that I’m seeing and worrying about are the pressures on food security, housing, healthcare access. And again, I think that for healthcare access in particular, people are going to get really anxious about it because it’s going to affect all of us. I mean, already we’re being told don’t come in for anything other than emergencies, and that’s just going to extend on and on. And I think for the healthcare arena in particular, this is going to be a huge long term effect. I mean, we’re already really strapped in terms of money and funding in the social services arena, especially in small communities like Adams County. So Adams County, we don’t stand out in terms of being the worst on anything and we’re a small community, so it’s hard for us to get dollars here to support a lot of these initiatives. So I think that there’s going to be that many more constraints on funding streams. And so this community has been pretty good in the past about being able to come together and come up with creative solutions, and already that’s happening. I mean, all week long there have been community call ins with organizations trying to work together to try to brace ourselves for what’s ahead.

President Bob Iuliano: What can the government be doing now, and by government I assume, I mean local, federal, state, to help the most vulnerable populations who, as you say, will be disproportionately affected by this, whether it is because of income or preexisting health conditions?

Amy Dailey: Well, I think there are a lot of things being talked about at state and federal government levels for sure. Protection of workers. So paid sick leave, flexible leave to take care of sick family members, immediate income assistance for people who are laid off. Certainly we need better safety measures for people who are still working trying to keep our infrastructure going. And certainly that can trickle down to institutions making those decisions as well. We’re seeing a lot of communities have moratoriums on evictions and utility shutoffs. Again, finding safe and decent housing for everyone is important right now. I think another thing that’s happening is, how do we figure out how to increase access to emergency services? We know that in situations like this domestic violence can increase. We’re going to have a mental health crisis to deal with. And those are some very immediate things, and again, those are going to be longer term issues to grapple with.

Amy Dailey: Substance use for sure could increase, and people are going to need access to mental health care providers and behavioral health care providers. Access to food. So right now we already have a lot of people who are food insecure on a weekly basis, let alone trying to stockpile enough food to be at home for a long time. So programs to help people shelter in place and feel like they have enough food to feed their families. We’re going to have to think about protecting our food system and our food workers. We have a lot of immigrants and migrant labor in this country and in this community in particular, and so how do we have protections in place for those individuals? And I think just on a basic level, how do we reduce some of the red tape that people have to go through to get assistance?

President Bob Iuliano: That’s a great answer. I will say that it gets me wondering though about the challenges of our federal system where everything is distributed in state, local governments. And so, invariably in that world there’s just remarkable variations from place to place, both in resources approach and the like. And so, in some cases that’s wonderful because it’s a hotbed of experimentation where we learn, but in times of crisis, that variation I think can be deeply consequential to people who find themselves on the wrong side of that spectrum. So, a couple of last questions. What do you think we can learn from this outbreak, if anything? Or is it too early to tell?

Amy Dailey: Well, no, I think there’s plenty to learn already. I think this crisis exposes huge gaps in our policies, whether it’s around pandemic preparedness, but also obviously these social protections that we’ve been talking about. David Williams, who is also a social epidemiologist, he often is saying, economic policy is health policy, housing policy is health policy, education policy is health policy, environmental policy ... And I’ll stop now. But the fact that we need all of these sectors involved in helping with this crisis, and I think learning about how interconnected all of these ... From an academic perspective, we talk about disciplines, and the liberal arts and how important the intersection of all of these facets of how this crisis is panning out is important. I’d also like to point out, as long as we’re talking about these different areas of the liberal arts, the importance of the humanities, in particular philosophers and ethicists right now.

Amy Dailey: I mean, we are faced with huge ethical questions right now. And what’s coming up in the media this week that’s really bothersome to me is this false question about, do we focus on public health or saving the economy? And of course we can’t separate these things. These are not separate issues. And the fact that it’s even coming out this way and being politicized is disheartening for sure. And as you were saying just a minute ago, ideally we would have thought about what those ethical considerations and frameworks are beforehand, so that as we go into a crisis, we have good ways of making decisions. Because no matter what, there’s not going to be a good decision, a really good decision here. I mean, we’re based with literally death here and ongoing suffering. And so how do we make those decisions ethically and how do we work together?

President Bob Iuliano: Well, and as I’m fond of saying, part of what also we teach is the ability to build bridges, and build coalitions and create those connections that move forward issues effectively. And what we’re seeing now is the importance of leaders who can really build those bridges, get those coalitions going, motivate and create the environment in which progress can be made. So boy, the world has changed dramatically in the last three weeks as you and I are sitting in our homes not able to go to work. We see this happening throughout the United States. Do you think there are long term implications that will follow from this experience that will change the way we as a society live and learn?

Amy Dailey: I’m still trying to remain optimistic that these social distancing efforts are going to make it so that the longest longer term implications are minimized. But, I mean hopefully we’ll learn things, like we shouldn’t wait for a pandemic to put these basic social protections in place. People are already experiencing all of these things, like food insecurity, and low wages and trying to survive, and this is just really amplifying those problems. And so hopefully we take this as an opportunity to actually do something about those issues longer term.

President Bob Iuliano: Amy, thank you for sharing your wisdom with us today. I suspect I know I will be relying upon it in the days and months to come as we think about how we as a college should respond to a set of related challenges. So, thank you very much.

President Bob Iuliano: As I look out at a campus that has responded in truly remarkable ways to an unprecedented moment in time, I could fill hours with stories suitable with a closing slice of life. I’ll focus on one, however, because it captures the essence of this place at this moment in time. And it’s from a social media post from our women’s lacrosse team featuring a quote from Liza Barr, a senior, an organization and management studies major and an outstanding member of our women’s lacrosse team. Now I could try to paraphrase what she wrote, but her words are so much more evocative and powerful than anything I would try to do instead. So let me instead quote a few lines from her posting.

President Bob Iuliano: “It is hard to express in a few words how much you have had an impact on. I would not be the person I am today without the high standards of this institution and lacrosse program. From the classroom to the field, Gettysburg demands greatness, and I am grateful to have been pushed to the peak of my potential academically and athletically. Thank you, Gettysburg, for teaching me that when it comes to adversity we can only control how we react to it. In times of crisis we cannot afford to be selfish. Some things are bigger than yourself. Now, more than ever, it is important to look at the bigger picture. Thank you, Gettysburg. I will continue to live by the lessons you have taught me and will strive to be an example of what it means to be Gettysburg great.”

President Bob Iuliano: We often observe that this is a special place. It is people like Liza who make it so.

President Bob Iuliano: Thanks for listening. If you’ve enjoyed this conversation and want to be notified of future episodes, please subscribe to Conversations Beneath the Cupola by visiting gettysburg.edu or wherever you get your podcasts. If you have a topic or suggestion for a future podcast, please email news@gettysburg.edu. Thank you. And until next time.