For the past 3.5 years, I’ve been going 2,000 mph just trying not to crash into the guardrail. Emergencies will do that, particularly in spaces that aren’t prepared. I’m finally able to slow down and process the good and bad in both my roles: being on the front lines of the response and publishing YLE.

Last week I was invited to the University of California San Francisco Grand Rounds— a formal meeting in which providers discuss the latest medical breakthroughs and research. It was the last of the COVID-19 series and a great discussion about what we learned. The recording is below.

I’ve also started a list my phone. The past few years are still a bit of a blur, so this is just a start. Below is what I’ve jotted down so far.

Lessons I learned:

• The three most important words: I don’t know.
• Approach novel threats with humility. Man this stupid virus gave us some surprises.
• Approach populations with humility. Helicoptering in is not the same thing as stakeholder engagement.
• There are only tough and tougher policy decisions during an emergency. Many decisions were leaps of faith. Schools were a great example.
• Public-private partnerships are critical: Operation Warp Speed. Google mobility data. CVS/Walgreens and vaccine distribution. Antigen tests and USPS. Contact tracing. Wastewater. Public health was brought to a new level.
• Humans don’t like being reminded of their vulnerabilities. It brings out a lot of hate and anger.
• We can do hard things: 91% of Americans 12+ years have the primary COVID-19 vaccine series. That’s absolutely huge.
• Public health is inherently political. Policy isn’t just based on science but also culture, psychology, politics, and values. A lot of the time we agree on data, but we value different priorities.
• Using public health as a partisan pawn, though, will cost lives. Using masks (or lack thereof) as a tribal symbol is a prime example.
• Scientific communication. Oh, where do I begin? This deserves its own YLE post.

Things I got wrong

Hindsight is 20/20. But there is a difference between being wrong vs. being off because of limited knowledge at the time. There are things I need to be better at in the future, regardless of the rapidly changing evidence. Here are some examples:

• Noise. I initially dismissed lab spillover theory because of the messenger (Trump) and because it was wrapped up in other conspiracy theories. I’m getting better at dealing with noise, but not perfect.
• Feasibility. I strongly supported CDC’s recommendation on masking under 5 years old, but I ultimately think the WHO got this right (mask over 5 years old). Families were kicked off flights because toddlers wouldn’t wear a mask without crying. I felt for those parents. I was that parent. Feasibility is a big part of public health adherence.
• Being partisan. I fell for the partisan bait many times. This isn’t how we build new foundations of trust.
• Being sloppy, like not vetting sources carefully enough or leaving an ACIP meeting early and sending millions the wrong recommendation. (I’m still embarrassed.)

Things I hope you learned

• Science is ever evolving. It never stops.
• A healthy population is a healthy economy. These interests are not competing, but rather complementary.
• Inequality is so very apparent in health and well-being.
• It’s really easy to forget how bad and scary it was. Revisionism is real and can happen unconsciously.
• When public health works, it’s invisible. But there are a ton of people working their butts off. As the Peace Corps say: It’s the toughest job you’ll ever love.
• Public health is a cycle of panic and neglect. We need to stop this. Supporting public health is just words unless it’s backed up with funding.

Bottom line

The pandemic made us move at incredible speed; we were bound to make mistakes. But, as Jonathan Mann said during the HIV era, “At the time of plague we did not flee; we did not hide; and we did not separate”. Here’s to learning, adapting, and being better prepared for tomorrow.

Love, YLE

“Your Local Epidemiologist (YLE)” is written by Dr. Katelyn Jetelina, MPH PhD—an epidemiologist, wife. During the day she is a senior scientific consultant to a number of organizations. At night she writes this newsletter. Her main goal is to “translate” the ever-evolving public health world so that people will be well equipped to make evidence-based decisions. This newsletter is free thanks to the generous support of fellow YLE community members. To support this effort, subscribe below: