Dr. David Aronoff is an infectious disease specialist and director of the Division of Infectious Diseases at the Vanderbilt University Medical Center. His time is regularly divided between seeing patients, teaching, and running a research laboratory; during the pandemic, he has served as a key public health communicator.
Blue Muse staff writer Julia Rodman spoke to him by phone to get a sense of what the pandemic has been like for someone in his position.
What was it like at the beginning of the pandemic for you?
I’m in the middle of Tennessee, and a lot of the early news about this disease was outside of the United States, so it was very difficult to comprehend what people were experiencing. It wasn’t until the pandemic hit the West Coast and the East Coast that my radar went up. In Tennessee, the first case of COVID-19 was announced in early March of 2020. Our infectious disease group knew right away: this is here now. The hospital system had put together a command center in the basement of the hospital. We were able to get real time information, communicate, and develop strategies around how we obtain and allocate PPE, how we protect our employees and patients, and how we diagnose something that we didn’t really have good diagnostic tests for at the time.
I will never forget the images of anxiety, exhaustion, panic, and sadness that were coming out—particularly from New York City. By the time the pandemic reached Tennessee, it became very clear to me that this was not a drill. This was a real major threat that was directly in my area of expertise as an infectious disease physician.
How did you respond when you realized the severity of the pandemic?
I felt very early on this moral obligation to drop everything I was doing and just pivot right into the pandemic and say, “Okay, how can we help and protect each other?” Early on, when people at the institution were asking me to do things, my answer was always “Yes” first, and ask questions later. My feeling was that there would be time to rest later, and this was the time to just do. I found that that was the response, not only from my division, but all over the medical center.
In early March of 2020, it’s not an exaggeration to say almost all I did for months was COVID-19 response. That included organizing our clinical responses and helping figure out how to give advice to our physicians and nurses in the hospital. We had to figure out how to develop new call schedules for covering when people outside and inside of our institution had questions, and also how to communicate with our external community.
How did you feel about the public response to the pandemic?
The blatant attempt to politicize the pandemic and the public health response has been extremely frustrating for me. This virus has zero ability to understand someone’s political bent, and the ways in which this virus is transmitted do not change based on whether someone has a particular political affiliation or not. So, speaking about this pandemic as if there’s one reality or truth that changes based on political leaning is bizarre and has resulted in people dying.
I have spent a lot of time trying to emphasize the importance of evidence-based medicine. At the same time, I’ve been trying to combat mythology and politically based opinions about the effectiveness of creating distance between ourselves and others—or wearing face coverings, or now getting immunized. I did not fully anticipate just how polarized the political system is in our country. It actually resulted in people taking stands on opposite ends of what to do about a viral pandemic. There are clearly facts about how it spreads and how we can prevent it from spreading.
And social media has played a role in this.
Social media can give platforms to people who all of a sudden are experts at epidemiology, public health, and medicine. It gives voice to dangerous opinions at a time when lives are on the line. A lot of that was really soul crushing. And yet, I felt that it was my job to just get out there and educate people and understand that I may need to change my approach to help people change their minds. However, as a single individual, there are going to be a lot of minds that I fail to change. I just have to be okay with that.
With the new vaccines, is herd immunity the next step in our efforts to end the pandemic?
You know, where I am right now in Tennessee, disease activity and hospitalizations are pretty flat. But you can contrast that with what’s happening in Michigan right now, where they have seen more cases in recent days than at any point in this pandemic. If we look globally at the numbers around the world, it’s the same thing—disease rates are really going up. That seems to be a function of the fact that there are still a lot of people who have not been infected yet. We’ve really struggled to get the vaccines out worldwide, and there are parts of the United States where vaccine uptake is still lagging. There are people who, this deep into the pandemic, have decided not to do anything anymore to prevent the spread. So that is all adding up to us having an important tension right now between the ongoing spread of SARS-CoV-2, and our efforts to create a herd immunity to end the pandemic.
“Because this virus doesn’t have a consciousness, it was able to teach us an important lesson about systemic racism that may have been unanticipated by some prior.”
The pandemic revealed the deeper issues rooted in society.
When we look at the disproportionate impact of COVID-19 on our BIPOC communities, we realize that’s telling us something much deeper and meaningful about ourselves as a society. And at the same time in history, watching the murder of George Floyd and Breonna Taylor has shown us what systemic racism can do in this pandemic. Because this virus doesn’t have a consciousness, it was able to teach us an important lesson about systemic racism that may have been unanticipated by some prior. It’s been very sad to see how it has impacted vulnerable people, and people who have been repressed through time. Sadly, as we’re seeing the disease in some parts of the world get better, we’re not really seeing those root causes of health inequity getting better.
Right now, it’s important that we continue to wear our masks and social distance. How long do you think we still need to continue that behavior?
On the one hand, I could see us doing more to respect social distancing and wearing masks during cold and flu season—just given the tremendous effect all of that seems to have had on the influenza this year, in addition to getting our flu shots. I would have no problem with wearing a mask just to avoid getting the flu. I am super hopeful that if we can get enough people vaccinated, that will allow us to relax social distancing and get back to crowded bars, restaurants, museums, and airplanes.
Will the COVID-19 vaccine be administered with a similar frequency as the Influenza vaccine?
Worldwide, there have been almost three million people dead from COVID-19. So, if you said to me, “If getting a shot every year would keep this from happening again, would you do it?” I would say, “Of course.” I would just go to CVS, buy too many candy bars, get a shot, and get out of there. We don’t really know what’s going to happen, but I do think we may see the emergence of some booster shots targeted against some of the variants that continue to cause problems. We’re going to have to continue to do a lot of viral sequencing and surveillance around the world—much more than we have ever done for influenza. But I’m fully prepared, willing, and able to get a shot every year if I don’t ever have to do this again.
“I think infectious diseases have always given us a lens through which we can see these interactions, but that understanding took on a really striking, accelerated, and amplified meaning as we’ve watched this pandemic play out across the world.”
What lessons have you learned?
There have been all sorts of unanticipated lessons I’ve learned through this pandemic. I’ve lived through pandemics like HIV, where we see infectious diseases disproportionately affect vulnerable people—because vulnerability can present itself based on economics, preexisting health care, and socio politics. Those factors are the reason why diseases like tuberculosis, HIV, and sexually transmitted infections are not balanced in terms of who they impact. That’s created a lot of important ongoing work in health equity and understanding how health policy, politics, and economics impact human health. I think infectious diseases have always given us a lens through which we can see these interactions, but that understanding took on a really striking, accelerated, and amplified meaning as we’ve watched this pandemic play out across the world.
And on a personal level?
It has been an absolute tectonic shift to humanity. And on the personal and professional level: it changed me as a human, it’s changed me as a leader, it’s changed me as a physician. I think on the whole, it’s changed me in some ways that are meaningful and positive. But I wouldn’t wish this kind of growth opportunity on anybody.
Julia Rodman is a Blue Muse staff writer
Additional Editing by Emma Nelson
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