COVID Five Years Later: From Lockdowns to Long COVID — and What Went Wrong

BIANNA GOLODRYGA, ANCHOR: Well, as President Trump’s reforms threaten to dismantle the world of health, our next guest is taking a look back to discover how we got here. Five years ago today, COVID-19 was declared a pandemic and the world changed forever. Since then, there have been over 700 million cases and 7 million deaths worldwide. As a COVID-19 coordinator under President Biden, Dr. Ashish Jha helped lead the U.S. response. And now, he joins Hari Sreenivasan to reflect on how the pandemic transformed society and how it continues to impact us today.

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HARI SREENIVASAN, INTERNATIONAL CORRESPONDENT: Bianna, thanks. Dr. Ashish Jha, thanks so much for joining us. We’re about five years out now from the beginning of COVID, and there is still long COVID, a few million people. I think 3 to 5 million Americans are describing symptoms consistent with that. First, I guess just to set the table for our audience, describe what this illness is.

DR. ASHISH JHA, FORMER COVID-19 RESPONSE COORDINATOR UNDER PRESIDENT BIDEN AND DEAN, BROWN UNIVERSITY SCHOOL OF PUBLIC HEALTH: Yes, well, first of all, Hari, thanks for having me back. You know, long COVID is basically a post-viral syndrome that we’ve seen this with other infectious disease, we saw this after the 1918 flu pandemic. It’s probably not one condition, it’s probably three or four different potential conditions. For some people they just had a really bad bout of COVID and just have ongoing symptoms. For others the infection might not have even been that severe, but it triggered an immunologic response, and they have essentially an autoimmune disorder. And there’s probably a subset of people who continue to have symptoms of persistent infection, chronic infection. So, it’s a mix of all three, but all three groups of people are continuing to suffer weeks, often months after their initial infection.

SREENIVASAN: For the people who, you know, say, my life hasn’t been the same, but I can’t really put my finger on it, when they go to their primary care physician there’s not like there’s some sort of test that we can do this to say, oh, you’ve got long COVID.

DR. JHA: Yes, that’s right. And unfortunately, what that has also meant is that some of these people have had their concerns dismissed or minimized, which of course is very unfortunate and wrong. The truth is, and again, we don’t have good estimates, but my best guess is sort of along yours, 3 to 5 million Americans continue to suffer. And there isn’t a single test. That’s why we need more research in this area, both to define the disease, but of course, ultimately, to find ways of treating these people so they can get better. There have been a few different treatments that have been tried. Some antivirals for long periods of time do seem to be helpful for a subset of the population, maybe that’s the group that might have a chronic infection. You know, until we more clearly define what the set of ailments are it’s going to be hard to find one treatment that’s going to work for everything. We probably won’t. So, what needs to happen right now is NIH needs to be funding studies that both define the populations a bit better. And then, within each population, we need to be trying new types of treatments, whether it’s immune modulation for people who have autoimmune disease, antiviral drugs, that research really needs to continue. Unfortunately, it just doesn’t seem to be a lot of interest in Congress or the administration in funding that work.

SREENIVASAN: All right. So, as we kind of head into this administration’s priorities, they want to cut costs wherever they can, research funding seems to be on the chopping block at several different agencies. So, do you think the NIH is going to be able to carry out the type of research that may affect and eventually help all these Americans?

DR. JHA: Yes, we started some of that work when I was at the Biden White House, but I will say that my senses that has largely come to a halt. I’m not hearing a lot of interest in this administration in continuing that work and certainly where Congress is right now, I’m very worried that there’s not going to be a continuation of support for research is going to help these Americans get better.

SREENIVASAN: I think people would understand that there are lingering physical effects, but there was a 2023 study from NIH that found an interesting correlation between kind of the mental health effects, the anxiety, the depression, even PTSD. How could that happen?

DR. JHA: And so, this is actually really important. And unfortunately, it gets misused by sort of COVID minimizers who say, ah, see, here’s the evidence that this is all just mental illness or just in people’s heads. The actual issue is that when you develop an acute illness and then all of a sudden you don’t really get better, let’s say six months, a year, two years later, that can be incredibly debilitating. And yes, it has physical effects, but it also obviously has mental health effects. You may have had very ambitious plans for your life. You may be an athlete. You may be somebody who had a vision of what you’d be able to do, and when that is really disrupted, it absolutely can cause anxiety, depression other symptoms. That doesn’t mean that COVID is all in your head, or somehow this COVID — long COVID is a mental health issue. The mental health issues are often a byproduct of people not recovering.

SREENIVASAN: There was a World Health Organization regional director in Europe who said this past October that we seem to have a collective amnesia about COVID-19. And do you agree with that?

DR. JHA: I do. You know, it’s interesting. When I was at the White House, I did this — I called up a whole bunch of historians to ask them about, you know, how do pandemics come to an end? What does history tell us? And the one theme every historian brought up is the idea of a collective amnesia that follows every major pandemic throughout human history. And I think it’s a little bit of a trauma reaction. It’s such a traumatic event for a society to go through a pandemic. And for some periods of time there is collective amnesia, then there’s an attempt to kind of rewrite history and say, actually, it was never that bad. Maybe we exaggerated and overdid it. Over time, my hope is we will settle in to understanding just how devastating COVID was and how we can learn the lessons to do better in the future.

SREENIVASAN: I wonder if those historians told you after those pandemics was the sort of reaction used as a political football? I mean, it seems to be that way now.

DR. JHA: It does. And I think throughout history we’ve seen that happen again and again. It has also been an impetus for a lot of good action. I think that a lot of people who think that a lot of the movement that happened for towards universal health systems, even the founding of NIH, all in the 1920s, to some extent, a reaction to the 1918 flu pandemic. If you go back into kind of prior times there are large political consequences that come out of pandemics and how they were responded to. So, I think this is, in some ways, to be expected. You always hope that we’re going to learn the lessons of history and do better, but we often find ourselves trapped by the same problems that our ancestors are in.

SREENIVASAN: You served in the Biden White House. You were the COVID-19 coordinator. And so, you have, you know, some insight into this. Are you surprised that here we are five years now and we have not used this pandemic as an opportunity to make those kinds of investments that we might have made 100 years ago after the 1918 flu pandemic?

DR. JHA: Yes. I’m worried, in some ways, that there is backsliding. I mean, I think certainly in the few years — the first years of the pandemic there were a lot of investments when I was at the White House. I spent a lot of time thinking not just about how do we bring COVID to an end, but how do we do better in the future? But I — you know, I’ve been talking to people in the Trump administration. I am worried in the larger landscape this sort of sliding back, pulling back on preparedness, not making the kind of investments that ensure that in the future when we hit another biological crisis, whether it’s pandemics or a biological attack that we are much, much better prepared. And I just worry that we’re not doing that right now.

SREENIVASAN: Were there episodes in the Biden administration in the response to the pandemic where the decisions were politicized, where there were — there was perhaps a medical prescription that you would have had and there were other factors that also weighed in on what to share with the public and when, what sort of steps we should all collectively take, where we should make our investments?

DR. JHA: Look, I think my experience, I can talk about the time I was there, which was obviously not during the entire administration, but my experience, what I would say is that on things where the public health answer was clear, it was pretty clear what to do, and we did it and we talked about it quite openly. When I think about promoting vaccines, promoting treatments, promoting testing for people who are infected, those are the right public health answers, and you saw the administration lean pretty heavily on that. There are a lot of other issues in which it is necessarily — and I say political is a — you know, not as a dirty word, but politics is how you negotiate different perspectives. There were places where the labor groups had a different view than the business groups who might have had a different view than CDC. And so, there was always that kind of conversation. You know, my job was officially the White House COVID-19 response coordinator. My job was trying to coordinate all of these different views to try to come to an answer in a way that all these sorts of different stakeholders could feel good about. We didn’t always get that right. But where I think the public health message was clear, we leaned in. But where there was a lot more uncertainty, you had to let everybody else weigh in with what their views were and then try to come to an answer that was sort of optimal for the American people.

SREENIVASAN: I asked that partly because there seems to be an interest in this Congress to relitigate some of what happened after the pandemic, how the decisions were taken. And I wonder, are you concerned, having had that job that you’ll have to testify in front of Congress?

DR. JHA: I’m not particularly concerned about me. What I am concerned about is sort of a rewriting of kind of what happened. I mean, do I think the Biden administration got everything right? They didn’t. Do I think — even when I was there, I don’t think I got everything right. And I think there’s plenty to look at and say, how do we do better overall. When I think about the mistakes over the last five years, some of it happened before President Biden came in. For instance, the way schools were handled, I think there is broad consensus that schools were closed for way too long. They should have opened up much earlier, in the fall of 2020. I have personally said publicly that even though I was very supportive of vaccine mandates, I believe they saved a lot of lives, you know, over the long run, I think they also fueled a lot of vaccine distrust, and I worry that maybe those that was the wrong policy decision. I think we need to have honest and open conversations about these things, Hari, because we’re going to face these kinds of challenges again, and trying to have a conversation in a very open, with a spirit of inquiry, acknowledging mistakes, trying to do better, that’s what we need to be doing, and not the sort of political litigation that is happening in Washington right now.

SREENIVASAN: I wonder if you’re seeing this from your perspective, which is this significant distrust of institutions, of government, of vaccines and science, and what are the consequences of that slide?

DR. JHA: Yes, this is probably the thing that worries me most when I think about the future. I mean, look, one of the huge successes of the COVID-19 pandemic was the ability to build vaccines very quickly, treatments very quickly. But none of that is useful if people don’t trust it enough to get vaccinated. We’re seeing outbreaks of measles. I worry about bird flu. And what has happened is while there is in fact a bigger distrust of institutions, people have also exploited mistakes public health officials have made to essentially try to discredit the entire public health enterprise. I remind people life expectancy in America has almost doubled in the last 100, 120 years, largely because of the interventions of medicine and public health. It’s been a huge boom for our health. And we have got to go back to basic principles of the scientific method. I think if we can do that, I think we communicate with people effectively about what the ups and downs of the scientific method is, I hope that we can begin to rebuild that trust, but it is not going to be done overnight.

SREENIVASAN: You mentioned the measles outbreak right now in Texas. And I wonder here we were as a nation so close to having completely eradicated it, were you surprised that a community in Texas had such a rapid spread?

DR. JHA: Yes. Well, measles for your audience knows that is the most contagious virus sort of known to humans, it is just incredibly contagious, it spreads very quickly. As soon as population immunity starts dropping below about 90, 95 percent. And so, what has happened in the last few years has been — actually there’s been a concerted campaign against vaccines for a long time, but it’s really caught, I think, wind in the last few years, obviously culminating in RFK Jr. becoming the health secretary of America. I mean, the person who’s done more to so distrust on vaccines now runs the health enterprise of the U.S. government. What it has done is cause a lot of people to question vaccines and vaccine effectiveness and vaccine safety and has left a lot of communities vulnerable. In that context, one is not surprised to see measles breaking out. It’s incredibly disappointing, especially when you start seeing people getting really sick and dying from measles, given how incredibly preventable all of this is.

SREENIVASAN: You know, speaking of RFK Jr., he had published an op-ed recently where he, I would say, promoted the use of vaccines. But what did you think of the op-ed?

DR. JHA: Well, first of all, it was great to see him promoting vaccines. I mean, thank goodness that at least he’s willing to do that. The unfortunate part here is that he also — and then he went and did an interview on Fox News. He also says a lot of things that are largely not just they’re wrong, and they also cause a lot of confusion. He talks a lot about treatments for measles. There actually are no real treatments for measles. Yes, vitamin A can be helpful for people who are vitamin A deficient, but it’s not a treatment for measles. He talks about cod liver oil. That was, by the way, cutting edge treatments in the 1930s. We don’t use cod liver oil anymore because we have vaccines. The problem with RFK Jr. is he buries the lead and sort of wraps it with a lot of other information that actually, frankly, confuses people. A real health secretary right now would be very clear, very unequivocal that everybody’s got to get vaccinated.

SREENIVASAN: You know, back in 2021 he was petitioning the FDA to revoke authorization for all COVID vaccines and to not approve any vaccines for it in the future. What are the consequences of that, considering now that the head of the FDA is someone who reports to him?

DR. JHA: Yes. So, first of all, obviously, I think we all hope that does not happen. I would set a terrible precedent. There is a mechanism for revoking vaccines when the safety and efficacy data come in suggesting that something doesn’t work, then we should remove it. That’s not what’s going on with COVID. The irony here is he was doing this to a vaccine that I would argue was the greatest accomplishment of the Trump administration during the year of the pandemic when they were in office, and that’s Operation Warp Speed, which was extraordinary, just great leadership, great success. And so, the question that is going to be, I think, in front of us is he going to try to do these kinds of things for other existing vaccines, not just measles, but polio others? And then, what is he going to do when the next vaccine for a deadly disease becomes available or comes in front of the FDA? Is he going to try to block it? We all hope he doesn’t, but we’re going to have to watch.

SREENIVASAN: You know, recently, the FDA canceled an advisory meeting that would help figure out what strains of the flu that we should target this coming fall. And we forget that flu is actually deadly for thousands of Americans every year. And I wonder if there are strains of the flu that do not have a vaccine out on store shelves, so to speak, does that compound the dangers to people who might also be infected by COVID-19?

DR. JHA: Yes. So, let’s remember, every year about 30 to 50 million Americans get infected with the flu. It’s pretty bad, pretty nasty. About 30,000 Americans, mostly older Americans die of flu every year, though some children and young adults as well. You know, we pick a strain by working with WHO and American expertise is very important to making sure that we get the right vaccine. The irony here, Hari, is by leaving WHO, which is what the administration has done, by canceling this meeting, chances are that we’re either going to not have a vaccine at all, which would be devastating for just millions and millions of Americans, or we’ll just have to go with the WHO strain and not have any input. And by withdrawing from WHO we actually end up becoming more dependent on WHO because there is an alternative mechanism for finding a vaccine. So, I worry a lot that the administration is putting ourselves kind of behind the eight ball. We’re going to make the vaccine selection process less effective, and we’re going to be more dependent on others and less reliant on our own expertise.

SREENIVASAN: I don’t know how the sort of scientific research private sector communities work when it comes to vaccines, but I wonder if they see kind of the signals with this new administration that there is just not as much of an incentive for us to be doing the research and trying to publish, so to speak, the data and trying to make the vaccines because we don’t even know whether the Americans are going to want to take the medicines in the first place.

DR. JHA: Yes. So, thankfully, there is a global community and much of Europe and many other places in the world remain very active and interested in protecting their elderly. And I think there is a large community of Americans who still want to kind of use modern medicine, who want to get vaccinated, who want to use treatments that are going to be available. So, there is sort of enough of a market for companies still to be in this space. What is happening, I think, with the way that the administration is dealing with NIH, the way they’re dealing with FDA and CDC, is there just making all of that harder and less effective. And so, I believe you’ll still see companies engaged in this space. I think you’ll still see products, but they’ll be slower, they won’t be as good, and people will be worse off for it and we’ll measure it in more people getting infected and unfortunately, more people dying of things like flu and COVID because we’re not doing the scientific best that we can.

SREENIVASAN: Former COVID-19 coordinator for the Biden White House and the current dean of Brown University School of Public Health, Dr. Ashish Jha, thanks so much for joining us.

DR. JHA: Thank you, Hari.