The moment everything changed

Craig Spencer: So I walked around my bedroom for 30 to 45 minutes learning from him about what he was going through and trying to provide some type of advice for what may come next. And it was just clear to me at that point that it was going to cause a lot of public health catastrophe, but also social catastrophe, because I was hearing it in the voice of a friend.

I knew that if this was going to be a problem, it was going to be a problem exactly where I was at at that moment, in New York City. There's no outbreak or problem that has a global footprint that does not show up in New York City. And probably within a week after that was when you had my wife being the person at Trader Joe's on the Upper West Side with two carts full of food and all of the things that we're probably going to need.

Ashish Jha: I was in Cambridge, Massachusetts in January of 2020 when I realized this was going to be a global pandemic. This was going to be a virus that was going to spread throughout the whole world. 

The first cases had popped up in both Seattle and in South Korea at the same time. And you just had a sense that, okay, those are very different places. This is going to spread and it's going to spread everywhere in the world.  And the real question at that time was, what was this going to be? Was this going to be transformative and going to kill millions of people, or was this going to be a problem for some but not others?

So, February 26th, I was in Switzerland. I was visiting a clinic and I got a phone call from a reporter from ProPublica. He actually gave me the download on how we still didn't have a functioning test, tests were not widely available and therefore we did not know how far and wide the virus had spread. That was the moment I realized America's kind of screwed.

How did your world change when you realized what was happening?

Jennifer Nuzzo: So I was testifying before congress in early February and I just remember sitting in the hearing and all of the questions we got in that hearing were political in nature. They were like, well, what do you think about China? And like, but don't you think these bans are going to work? It was all political. 

And I remember feeling incredibly frustrated that we were in a pandemic even if nobody was calling in at that point. And there was so much for us to do. We had to get nursing homes ready. We had to think about protecting prisons. There were just so many different things that we had to do. And nobody was doing it. 

That was what I thought was a very doable list of actions that we needed to take. Not all of it was easy, but there were a lot of things that I thought we could easily do. And we were just wasting time. And that felt very frustrating.

Scott Rivkees: If you see hurricanes coming to Florida, you'll see the governor being interviewed, and this is in the background. Big TV screens up on the ceilings, curved desks, where we bring together all different agencies.

And we're looking at the news and seeing people being welded into their homes in Wuhan, China. And then, they had shots of an emergency field hospital, 1,000 beds, 2,000 beds being constructed in a two week period of time. And when this came on, I remember Jared and I looking at each other and saying, “My gosh, this is going to be incredibly serious.” 

Philip Chan: At the time, I was serving as a medical consultant for the Rhode Island Department of Health.

It was actually on a Saturday, and I remember it very vividly. I was visiting my parents in New Hampshire. It was cold out in New Hampshire, snow on the ground, and I remember just eating a big dinner and just lounging in the chair that my mom keeps by her fireplace.

I got the call from the health department. And I remember that my colleague at the health department said, “What are you doing? Where are you?” And I knew right then that we had our first case of COVID-19.

This was the first patient admitted to one of the local hospitals with pneumonia. At that time, we were only very selectively testing people, so in retrospect, we believe that COVID was much underestimated, even at that point in time.

You know, in retrospect, it was one of the last times I'd traveled up to New Hampshire during 2020 to visit my parents because of the whole shutdown. We had an all hands on deck meeting the next morning at 8 AM to start what was going to be a very long journey through the COVID pandemic.

Ashish Jha: I think it was Monday morning. I was running the Harvard Global Health Institute at the time. There were about 35 staff working on a variety of different topics. Called an all staff meeting and I said to everybody, whatever you all were working on on Friday, starting today, everybody's working on this virus. And pretty much everybody was shocked, and several of my team members were like, ‘Really?’ Like, it seems like a little bit of an overreaction. And I said, ‘I don't think it's an overreaction. I think we have got to stop everything else we're doing and focus on this.’

Well about a week or ten days later, we started seeing a lot of other things change. The NBA shut down, and I think at that point everybody realized the world had changed. So that was pretty rapid.

The virus had become widespread, and the world began shutting down. What happened next?

Jennifer Nuzzo: I remember getting a text from a mom friend who wrote to me and said, “Oh my gosh, two weeks. What are we going to do? How are we going to survive two weeks with no school?” And I remember seeing that text, and I wrote her back, “It's not going to be two weeks. It's going to be much longer.”

I had friends reach out, friends who don't know me professionally, they've known me personally, and they'd send me texts like, oh, this is what you've been waiting for, isn't it? And I remember thinking to myself, I really wish I was not relevant in this moment, because there is literally no escaping it. 

I think about all those people that during the pandemic started making sourdough, or banana bread, or whatever the trends were. And I was thinking, it would've been nice to have a little bit of a break and have a pandemic-related hobby. My husband joked that I just wake up at three in the morning and write op-eds as my hobby. But mostly it was just trying to figure out how we can get ourselves out of the situation.

Craig Spencer: I remember at some point in March where it went from, in the span of just a few days, trying to find the one person with COVID in the ER to trying to find anyone without COVID. I mean, it was almost overnight that it just inundated the emergency room. And I remember towards the end of March, maybe the first few days of April, walking into one of our community hospitals at the northern end of Manhattan. Not very big. A few dozen beds.

And I remember going into the hospital through the ambulance entrance and walking across what felt like a threshold into the apocalypse. Walking through a double set of doors and just hearing nothing but beeping. It felt like the machines had taken over because those people who were sick that first week, who were deathly ill that second week, were now all on ventilators, were all on life support. 

So I remember walking into this space, seeing nothing but a sea of lifeless bodies, hearing nothing but just the continuous chirping of machines and drips and medications, knowing that we weren't going to have enough people to take care of patients that day, knowing that more people would almost certainly die that day than any of the days that I worked in West Africa during the Ebola outbreak. And I remember thinking, no matter how hard I or anyone tries to explain what this looks and feels like, there's just like no way that people are ever gonna be able to envision what this moment is and what it means.

People don't realize this but normally very rarely do our patients die. I can go like a month, two months without seeing people die as an emergency physician. It was impossible to go, some days, like an hour or two without having a patient die. And so for my friends who were battle-hardened emergency physicians for a decade or more in some of the toughest places in New York City, this just really jolted them. What do you do when one of your nurses that you've worked with for a really long time comes out of retirement to try and bolster the nursing staff that’s getting sick and ultimately ends up dying themselves?

And then after work I would go home, take off my clothes at the door, put it all into a bag, and wash that and then go directly to the shower. And there were a couple of times where my daughter who was just walking at that point would see me come home and would run to me and my wife would have to maybe give her a little baby hip check to say, you know, “No, no, hold on, hold on, daddy will come to you in a bit.” 

That happened quite a few times. So yeah, the goal was come home, try to decontaminate personally, but also just kind of mentally, 'cause you don't want to bring either a virus or really that, that sadness, into your household. You know, it was going to come in regardless, but I had worked in places before that were really tough where I'd seen these things and I was maybe a little bit better at compartmentalizing. 

Ashish Jha: For me, the floodgates opened. I started doing a lot of media. There were days I was getting like 200 media calls a day, and doing like 40 plus media hits a day, between TV, newspapers, magazines, etc. And that went on for weeks, and I remember thinking, this is going to stop. And the reason it's going to stop is that my mental model was that any day now, you're going to start getting daily briefings from the CDC, and they're going to lecture all the data and the insights, and then I'll start getting occasional phone calls where somebody will ask, “Hey, the CDC said this, do you agree or disagree?” Those CDC daily briefings never came. Instead, the media stuff continued.

I was working like 18, 20 hours a day, seven days a week. And then eventually by May, I put in– I know this all sounds crazy now– but I put in this new rule that said I don't do media on Saturdays. And that was my day of like seeing my family. And also, reading and catching up on things.

But going to work every day, it was very surreal to drive into Harvard Square. There's no one on the streets. And when I was doing media, especially when I was doing TV, it was a very odd experience, like, when I think about a CNN hit– It's four minutes long. I would stare at a blank screen. I would hear the anchor's voice in my ear, and I would just speak to a blank screen for four minutes, and then the hit would be over. And then I go back to doing whatever else I was doing.

So you never had a sense that anybody else was like watching any of this. And because we weren't out there socializing, it wasn't like I'd go out for drinks on a Friday night and people would say, “Hey, I saw you on CNN.” There was none of that.

I remember at some point into April, I just thought, why am I doing this? And I was talking to a friend of mine, and he said, actually, this is useful and it's public health. Like, public health begins with the public. And in a moment where the public doesn't know what to believe and what's going on, having somebody they trust tell them how they think about the problem is really useful. I mean, I wasn't out there saying, here's what's going to happen. I didn't know. But I could walk them through what I was seeing, what I was thinking, how I was interpreting things, how I was behaving and what I was recommending to my family and friends. And I realized people found that useful. And I thought, okay, that's part of my job then.

How did public health messaging change during the pandemic? Do you feel like we fell short?

Ashish Jha: One of the slogans that I actually always disliked, was this idea of “trust the science” or “follow the science.” And that was actually the wrong way to communicate to the American people. It wasn't about trusting the science, it was about following the scientific process. The idea became that there are right answers that science gives us. 

But in a dynamic pandemic where the virus is changing and our knowledge of the virus is changing, there is no one right answer that's going to be true the whole time. And what we needed to do, better than we did, and I'm guilty of this, is explain the scientific process to people. That this is the best that we know right now, but we will change our minds as we learn more things. Any answer you give that’s simple and clean today is going to be wrong six months from now. 

I still find it really remarkable, there are people who will go back and find a tweet of mine from November of 2020 and say, “What happened to this guy?” I'm like, I'll tell you what happened to that guy. He got vaccinated, as did the rest of the country. You don't want my advice from November 2020 to make sense in March of 2025. That's crazy. 

And the inability to shift, because we had said the science says X, I think boxed public health into a lot of bad decisions that they could not unwind themselves from. And I think that we all would have done better if we had explained what the scientific process is, how it's self-updating, how it's self-correcting. How you get stuff wrong and that's okay because you get better over time. 

Craig Spencer: I think there's massive amounts of learning for the field of public health, right? We've beat these to a pulp in the past couple years. We need to be honest, and we need to involve communities more, and we need to think about our messaging. And I think that those things are true. 

I also think that we conflate the problems with public health with larger societal problems. An example is what's happened in trust overall, not just in public health, not just in medicine. If you look at trust in the Supreme Court, in the presidency, in any of our political institutions, in any of the things that we've long considered true and dear. They have plummeted over the past 50 years, from highs to incredible lows.

So I think public health is not an outlier in that. And I'm worried that so much of the finger pointing goes at public health, when it turns out we all need to do better. We need to have really difficult conversations with people we don't agree with and figure out the places that we do agree, and move forward on that. The polarization in every single aspect of our life is going to make it harder for us, not just to move forward politically, but as a field in public health. And until we do that, I think we are all worse off.

What gives you hope for the next pandemic?

Jennifer Nuzzo: I really was heartened by how many people just kind of rolled up their sleeves and decided to pitch in and help. Particularly academics. They were behavioral scientists, data scientists, they just rolled up their sleeves and said, “What can I do to help?”

People were stepping into roles that they had never occupied before just because they are like, you know what, there's a crisis. I think it really speaks to what's best about America, that we have this remarkable scientific capacity, this remarkable sense that democracy breeds optimism, breeds ingenuity. You know when pressed and when stressed, people do really step up and try to help.

So as much as I think we look back five years ago on COVID with a lot of grief and trauma and reflecting on the fact that we lost more than more than 1.6 million American lives. I think it's also important to look back and kind of remind ourselves of our resilience and the ingenuity that we saw happen. And so I think that's what I choose to focus on. 

This is not the first pandemic. We will continue to see these sorts of events happen. But it is my hope that we can channel that innovative spirit and sort of use that as our kind of North Star for thinking about how we can live in a world where these events will happen more and more likely, but live in a way that we don't allow them to just upend our lives, that we can be resilient in the face of them.