How should models of pandemic illnesses be constructed? What are the racial disparities in clinical outcomes for patients with COVID-19? How are emergency room physicians coping with the stress of an overwhelmed hospital system? These are just some of the questions explored by panelists who took part in a session on social sciences and modeling during the Cornell COVID-19 Summit, held virtually November 4–5.
The session took place on the second day of the summit and featured researchers from Cornell’s Ithaca campus and from Weill Cornell Medicine. Maria Fitzpatrick, Policy and Management/Economics and associate vice provost for social sciences, chaired the session.
Nathaniel Hupert, Population Health Sciences, Weill Cornell Medicine, explored how experts have modeled the COVID-19 pandemic, especially the model created by Imperial College London, which predicted a mortality rate in the United States of 2.2 million people if no interventions were used. That model and most others used to guide policy early in the pandemic assumed that COVID-19 would act like influenza (especially the pandemic of 1918–19), but this assumption may not have been appropriate, Hupert said. He stressed that the tension between the urge to quickly provide modeling results to policymakers needs to be tempered by caution about the many unknowns for an emerging disease.
“The optimal strategy for saving lives in a COVID-19 epidemic is different from that anticipated for an influenza epidemic, with a different mortality age profile,” he said. Hupert then asked why models of the health impact of COVID-19 typically focus only on that one disease. “Given the totality of the imposition of the global lockdowns on health, generally—and you could say, public health, but also livelihood, and nutrition and famine in places that are prone to that— focusing models and response strategies on the impact of this one disease may not be the best approach from a public health perspective. There are many factors and many sciences that go into creating public health policy, and they should not be neglected even when modeling COVID.”
Hupert then highlighted an alternative participatory modeling approach he helped develop with the University of Oxford: the COVID-19 International Modeling (CoMo) Consortium’s web-based, health-care modeling engine that is in use by 46 nations across the globe to assess the impact of policy responses to the COVID-19 pandemic.
Health Disparities Driving Impact on Minority Populations
Because of health disparities, the pandemic has had a greater impact on minority populations, especially African Americans, who have a much higher rate of death from COVID-19, said Melissa B. Davis, Surgery, Weill Cornell Medicine. In collaboration with Weill Cornell Medicine’s Caryl and Israel Englander Institute for Precision Medicine and the Clinical and Translational Science Center, she is investigating social and biological determinants of health outcomes, pinpointing those that had the greatest influence on morbidity, including whether a COVID-19 patient’s neighborhood scored high on the Neighborhood Deprivation Index, as well as whether a patient has high inflammatory markers in their cells. Looking at genetics, Davis pointed out that patients with African ancestry have a high chance of inheriting an allele, known as Duffy-null, that affects systemic inflammation and may be responsible for initiating and prolonging severe cytokine storms that can cause death.
Quality Improvements Aimed at Reducing Toll on Health-Care Workers
The continuing nature of the pandemic has taken a large emotional toll on health-care workers, especially emergency physicians and frontline workers, said Jodie Nghiem, a Weill Cornell Medicine medical student. She and fellow medical student Kaela Cohan, under the direction of Renu Mital and Lucy Willis, Medicine, Weill Cornell Medicine, and Lynn Jiang, an instructor in Emergency Medicine, Weill Cornell Medicine, carried out a quality improvement project specifically geared toward emergency medicine, addressing physician stressors and wellness resources between March and August 2020. “Between March 1 and June 30, about 28 percent of the respondents developed symptoms of COVID-19,” Nghiem said. “So that really shows the impact on the physician population.”
“The World Health Organization (WHO) labeled misinformation an infodemic.”
The physicians the team surveyed in Weill Cornell Medicine’s Department of Emergency Medicine identified a desire for increased personal protective equipment (PPE) availability and social distancing; transparent, timely, and consistent communication; and job-enabling and peer support–centered resources. Nghiem concluded that health-care institutions must recognize and address these issues when crafting a physician wellness strategy, which will be crucial in public health crises both now and in the future.
A Registry of Clinical Characteristics Helps Answer Questions
Monika M. Safford, chief of the Division of General Internal Medicine at Weill Cornell Medicine, said that when the COVID-19 crisis hit New York City in late spring, she wanted to assist hospital clinicians with their most pressing clinical questions. In response, they asked her for help in figuring out the signs—clinical observations rather than lab or blood tests—indicating whether patients stable enough to be admitted to the floor warranted closer observation because of the high risk of sudden deterioration that became a hallmark of this disease.
Safford then helped create a registry of patient information and coauthored one of the first studies describing the clinical characteristics of COVID-19 in the United States. Since then, many more studies have been published that use information from the registry, she said, inviting audience members to take advantage of the registry data for their own research.
Misinformation Degrades Trust in Public Health Guidance
COVID-19 misinformation has been a major issue during the pandemic, according to Sarah E. Kreps, Government. “The World Health Organization (WHO) labeled misinformation an infodemic,” she said. “This is important because the public has to have trust in public health authorities to take that guidance seriously.”
Kreps looked at whether people were more likely to believe fake content versus true content and whether their political leanings played a role in that, as well as whether political endorsements of new COVID-19 vaccines carried more weight than endorsements by WHO or the Centers for Disease Control, among other things. “Political aspects and endorsements really matter almost as much as whether the vaccine works,” Kreps said. “We are up against the backdrop of the most polarized political climate we’ve had since Reconstruction after the Civil War.”
Additional panelists included Aditya Vashistha, Information Science; Peter I. Frazier, Operations Research and Information Engineering; B Shayak, doctoral student in Theoretical and Applied Mechanics; Gen Meredith, associate director of the Master of Public Health Program; Harriet Okronipa, postdoctoral associate with the Fiorella group, Population Medicine and Diagnostic Sciences; Daniela Marin-Hernandez, postdoctoral associate in medicine at Weill Cornell Medicine; and Arnab Ghosh, Medicine, Weill Cornell Medicine.
The event was sponsored by the Office of the Vice President for Research and Innovation, the Office of the Vice Provost for Academic Integration, and the Office of the Senior Associate Dean for Research at Weill Cornell Medicine.