Fighting the COVID "Info-demic"

Segment Description: Saskia v. Popescu, PhD, MPH, MA, CIC, a senior infection prevention epidemiologist at a Phoenix, Arizona-based health system, and frequent Contagion contributor, discusses vaccine development, fighting COVID misinformation, and lessons learned from the pandemic with Contagion editorial director Allie Ward.

Interview transcript (modified slightly for readability):

Contagion^®: Hi, I'm Allie Ward, editorial director of Contagion^®, and here with me today is Dr. Saskia Popescu, a senior infection prevention epidemiologist at a Phoenix, Arizona-based health system, and a regular Contagion^® contributor. Dr. Popescu, thank you for joining me today. First of all, how are you doing? What has your day-to-day been like in quarantine?

Saskia v. Popescu, PhD, MPH, MA, CIC: It's been pretty busy. I don't feel the quarantine as much because I'm still going to the hospital every day for work, so it is kind of a weird feeling that everybody else is in quarantine but I'm still going in. Especially as things open, it's been busy. In Arizona, we're definitely seeing an increase in hospitalizations and COVID-19 cases, so it's definitely pretty busy. It hasn't really slowed down.

Contagion^®: We got some news this week and some preliminary data from Moderna about a potential vaccine. Are you encouraged by this information? What are your thoughts on a vaccine for COVID?

Popescu: I'm definitely encouraged. I think the important piece with all of the conversations regarding vaccines is to be cautiously optimistic and not be too excited about any 6-month turnaround. Vaccine development is a very long process. I think a year is a good estimate. But realistically, we don't have a vaccine for MERS, we don't have one for SARS, and those were years and years ago, so I do think it is important that we have realistic expectations when it comes to vaccine development. I'm hopeful that it will be sooner but I think the biggest piece is not to be banking on this because I do worry that people are going to think, ‘Oh, a vaccine is going to be available soon. We don't have to worry about staying at home or doing all of those other things.’ They may not be the most fun things to do but are critical for keeping case counts low.

Contagion^®: Right, and that sort of ties into my next question, which is about COVID. misinformation. Sometimes members of the public hear “vaccine” and think, ‘Oh, this is all going to be over in the next 6 months.’ How do we, working in health care, fight that misinformation?

Popescu: That's a great question. I think it's tough. I have never felt this level of misinformation in my entire career, even when we were dealing with Ebola in 2014. It's just a vastly different experience, and I think that's because we're all living it. We're all dealing with it right now unlike Ebola where we had a single unexpected case in Dallas, Texas. Every one of us knows someone who has had COVID-19; we're all living this pandemic, and so there's that ‘info-demic’, that information overload. Unfortunately, that also means disinformation and misinformation. It's very, very real for us, especially, I'm sure you've seen, on social media. One thing I have been working to do is when I'm rounding with my health care workers out on the units focusing on [personal protective equipment] education and infection control measures, I also make sure to take the time to ask them, ‘Do you have any questions? Have you read anything online that concerns you?’ Or I might even bring up proactively some studies that I've seen are getting a lot of traction in the news sources, but not necessarily in the right way or they're not being explained appropriately. And there tends to be more sensationalism in some cases. I try to focus on those, [such as] the airborne transmission [narrative].

I don't have a great strategy for it outside of trying to get ahead of it and making sure that I spend time with health care providers and ask them if they have questions, because I'd rather have those conversations even if it means spending 50% of my time doing that. It's better to have those questions asked now and to give them the correct information than to have them be worried for the wrong reasons about something that they read online. I also think all of us can try and do our part. We all have friends or family on social media who are sharing things that you're just like, ‘Oh my gosh, I can't believe you're doing this right now.’ So I really try to encourage, in those situations, to share with them the public health department websites, the [US Centers for Disease Control and Prevention], and help guide them in the right direction because it's challenging, it's exhausting. But hopefully we can try and help some people avoid bad information and more fear than they need to be experiencing right now.

Contagion^®: Definitely. You just mentioned social media, and I've noticed that you, in particular, have made your platform on social media a place where you're disseminating factual information and fighting that misinformation. You tweeted recently about the large-scale rollout of serology tests for health care staff, but you cautioned against doing it too quickly. Can you explain your concerns with that?

Popescu: It's May. This outbreak really started to happen in late December, early January, so it really hasn't been that long and we are, as I always say, building the bridge as we cross it, so I think it's very important as we roll out this new testing [that] we have to caution with, we don't really know what immunity looks like right now. My concern is as we roll out serology testing, what does that testing mean? How sensitive or specific is it? But also, just because you might have an IgG positive or reactive, I should say, what does that really mean in the long term? I just I worry that we're putting a lot of emphasis and banking on these results without really, truly understanding what they look like. I do think it is important, especially as hospitals might roll out widespread serology testing for their health care workers, to caution that with ‘this might not mean you're immune forever. These are the limitations of these serology studies.’ Just be mindful that there is some room for error. We're still figuring that out, but you still need to be safe, you still need to take the necessary precautions. That's my big concern. It really has to be communicated that there are some limitations to this and we're still really learning to understand immunology in this.

Contagion^®: How do you see COVID changing the health care system?

Popescu: I think a couple of things. In some regards, it has shown us that we can do some work remotely. I know that health care traditionally has been a little resistant to that, [and] I'm hoping this will mean we can do a little bit more teleworking. But I also think it has really shown us that we are very dependent on supply chains. We need to be working towards more sustainable PPE [and] things that can truly be reprocessed and not just emergently reprocessed like an N95 [mask], but something that's a little bit more durable and can truly, truly be disinfected.

I also think this will hopefully encourage hospitals to invest in preparedness for infectious diseases, and those are costly endeavors that don't always really get a return on the profit or on the investment, if that makes sense. There was a study that came out that found that hospitals felt more prepared for Ebola since 2014, but that ultimately their leadership found that it was really expensive to keep investing in these efforts. There were a lot of other competing priorities, so I think COVID-19 has really shown you have to keep preparing in biopreparedness and health care.

Contagion^®: It's kind of that whole “it's not a matter of if, but when” thing.

Popescu: It's so impacting. This has totally shaken us to our core, and it's really showing a lot of our vulnerabilities. My goal is that we learn from those and we see them as opportunities for improvement and not necessarily cracks and fissures in our systems. They were vulnerabilities but that doesn't mean we can't fix them. The trick, though, is learning from those and addressing those so that not just for COVID-, [but] if we have other surges and spikes in the future [with] any kind of other biological event.

Contagion^®: That's definitely a big lesson and a big takeaway from this. Are there any other lessons that you think infection prevention professionals are taking away from this pandemic?

Popescu: I think this has just been another reminder, not just 6 years after Ebola, that our jobs really encourage emerging infectious diseases and emergency preparedness. I think it's very easy for people to assume infection prevention is focused solely on health care-associated infections—[central line-associated bloodstream infections] and surgical site infections—but our job scope has really expanded beyond that. It's so important that we invest the time and the resources to educate ourselves and to broaden that scope and modernize infection control.

Contagion^®: Dr. Popescu, is there anything else that you'd like to add?

Popescu: No, thanks so much for having me. I appreciate it.

Contagion^®: Thank you.