Harvard T.H. Chan School of Public Health’s Barry Bloom, Joan L. and Julius H. Jacobson Research Professor of Public Health, offers context about the news that two experimental vaccines appear to confer a high level of protection from the coronavirus.

Q&A

Barry Bloom

Chan School: Within the space of a week, we’ve heard about not one, but two potentially extremely effective coronavirus vaccines — one from Pfizer/BioNTech, reportedly 90 percent effective, and now one from Moderna, nearly 95 percent effective. How encouraged should we be about these preliminary results?

Bloom: I think we have to be very grateful that we have two vaccines off the bat that look to be relatively safe, except for some minor short-term inconveniences — such as fevers and muscle pain, that you get from almost every vaccine — and have a much higher degree of protection than I think most experts would have predicted.

There’s a lot of science still to be done. We don’t yet know how long the antibody responses last that correlate with protection. We know that the vaccines are producing an immune response against the [coronavirus’s] spike protein. But do we know that the key response is neutralizing antibodies — the type of antibodies that can stop infection? If that were the case, can we measure levels of neutralizing antibodies for every new vaccine and have a pretty good guess that they too will be 90 percent or 95 percent effective? In the case of the Moderna vaccine, there were 95 recipients of the placebo who got COVID disease, but there were five in the vaccine group. We’d love to know: Did those five fail to make neutralizing antibodies? Or did they make neutralizing antibodies, but not enough, or not efficiently enough?

This is a terrific first start and we’re just going to have to follow along to see how long the immune responses that appear to be protective will endure in the vast majority of the population.

Chan School: What do we know about the safety of these two vaccines?

Bloom: For safety, you really want to follow participants in trials for two years. We don’t have the luxury of doing that. We’re in the middle of a pandemic that’s killing people and hospitalizing people.

We know that the most serious adverse effects that come from vaccines primarily occur within two months after the last shot. So the Food and Drug Administration will be looking at the people who were vaccinated and followed over two months after their last shot. The hope is that there will not be any serious adverse effects. If that’s the case, I think we can be pretty confident that the vaccines are safe. But ideally the vaccine recipients should be followed up for rare adverse effects for two years in post-licensure surveillance.

Chan School: Should people keep taking public health precautions even when vaccines become widely available?

Bloom: There will still be lots of people who are not vaccinated in the first six months or year after vaccines are available, and they will have the capacity to transmit infection. And I would point out that vaccines are wonderful but they’re not perfect. You can overwhelm an immune response with a high level of virus or bacteria, so we will need to wear masks, we will need to be protective, even if we have vaccines, until a high proportion of people are immune.

There are three worries that the public health community has now. The first is, can the country get the various vaccines to people and keep records on when they need boosters and any serious adverse effects? Another is, now that some vaccines appear to be effective, will people take them? A third is, if they take them, will they engage in risky behavior and not wear masks and feel they can congregate in bars all night, where even with the vaccine they may not be protected and be at some risk? Those are challenges for communications, for education, and for political advocacy, best done at the community level to persuade people to protect themselves and everyone else, with or without a vaccine, until everybody is protected, by carrying out the simplest of public health measures.

Although metabolic conditions such as obesity and Type 2 diabetes have been linked to an increased risk of COVID-19, as well as an increased risk of experiencing serious symptoms once infected, the impact of diet on these risks is unknown. In a recent study led by researchers at Harvard-affiliated Massachusetts General Hospital (MGH) and published in Gut, people whose diets were based on healthy plant-based foods had lower risks on both counts. The beneficial effects of diet on COVID-19 risk seemed especially relevant in individuals living in areas of high socioeconomic deprivation.

“Previous reports suggest that poor nutrition is a common feature among groups disproportionately affected by the pandemic, but data on the association between diet and COVID-19 risk and severity are lacking,” says lead author Jordi Merino, a research associate at the Diabetes Unit and Center for Genomic Medicine at MGH and an instructor in medicine at Harvard Medical School.

For the study, Merino and his colleagues examined data on 592,571 participants of the smartphone-based COVID-19 Symptom Study. Participants lived in the U.K. and the U.S., and they were recruited from March 24, 2020 and followed until Dec. 2, 2020. At the start of the study, participants completed a questionnaire that asked about their dietary habits before the pandemic. Diet quality was assessed using a healthful Plant-Based Diet Score that emphasizes healthy plant foods such as fruits and vegetables.

During follow-up, 31,831 participants developed COVID-19. Compared with individuals in the lowest quartile of the diet score, those in the highest quartile had a 9 percent lower risk of developing COVID-19 and a 41 percent lower risk of developing severe COVID-19. “These findings were consistent across a range of sensitivity analysis accounting for other healthy behaviors, social determinants of health and community virus transmission rates,” says Merino.

“Although we cannot emphasize enough the importance of getting vaccinated and wearing a mask in crowded indoor settings, our study suggests that individuals can also potentially reduce their risk of getting COVID-19 or having poor outcomes by paying attention to their diet,” says co-senior author Andrew Chan, a gastroenterologist and chief of the Clinical and Translational Epidemiology Unit at MGH.

The researchers also found a synergistic relationship between poor diet and increased socioeconomic deprivation with COVID-19 risk that was higher than the sum of the risk associated with each factor alone.

“Our models estimate that nearly a third of COVID-19 cases would have been prevented if one of two exposures — diet or deprivation — were not present,” says Merino.

The results also suggest that public health strategies that improve access to healthy foods and address social determinants of health may help to reduce the burden of the COVID-19 pandemic.

“Our findings are a call to governments and stakeholders to prioritize healthy diets and wellbeing with impactful policies, otherwise we risk losing decades of economic progress and a substantial increase in health disparities,” says Merino.

The study was co-led by investigators at Kings College London. Co-authors include Amit D. Joshi, Long H. Nguyen, Emily R. Leeming, Mohsen Mazidi, David A. Drew, Rachel Gibson,
 Mark S. Graham, Chun-Han Lo, Joan Capdevila, Benjamin Murray, Christina Hu, Somesh Selvachandran, Alexander Hammers, Shilpa N. Bhupathiraju, Shreela V. Sharma, Carole Sudre, Christina M. Astley, Jorge E. Chavarro, Sohee Kwon, Wenjie Ma, Cristina Menni,
 Walter C. Willett, Sebastien Ourselin, Claire J. Steves, Jonathan Wolf,
 Paul W. Franks, Timothy D. Spector, Sarah Berry, and Andrew T. Chan.

Funding for the study was provided by the National Institutes of Health, the National Institute for Health Research, the U.K. Medical Research Council/Engineering and Physical Sciences Research Council, the Wellcome Trust, the Massachusetts Consortium on Pathogen Readiness, the American Gastroenterological Association, the American Diabetes Association, the Alzheimer’s Society and Zoe Ltd.

Pfizer and BioNTech said Monday that their coronavirus vaccine, already authorized for those 12 and older, has been shown to be safe and effective in young children ages 5 to 11, which potentially provides a pathway toward inoculating the vast majority of U.S. schoolchildren against COVID-19. Ofer Levy, professor of pediatrics at Harvard Medical School and director of the Precision Vaccines Program at Boston Children’s Hospital, sits on a Food and Drug Administration advisory panel for coronavirus vaccines. He spoke with the Gazette about the announcement. This interview was edited for clarity and length.

Q&A

Ofer Levy

Gazette: Was Monday’s announcement an expected event?

Levy: This news is welcome news — I think that’s the word for it. I am a member of the Food and Drug Administration Advisory Committee on the Coronavirus Vaccines and, as you know, they are taking an age de-escalation approach to studying these vaccines. It started with older individuals who are at higher risk of severe COVID and then marched down in age. This highlights that age matters: Children are not little adults. It was the Greek philosopher Heraclitus who said, “The only constant thing in life is change,” and the immune system is no different. From the day we’re born to the day we die, our immune system is changing, so you have to do the study for safety and efficacy. The sponsor in this case, Pfizer, has announced that their data suggests safety and efficacy in kids 5 to 11 years of age. I am just looking at news reports, but they are pointing to a lower dose, maybe a third of the adult dose. I can’t prejudge these data until I see them, but it’s welcome news. The FDA will decide if the data is there to the point that they want to make a decision and whether they will call a meeting of our Vaccines and Related Biological Products Advisory Committee.

Gazette: Would your panel make a recommendation before emergency-use authorization is given?

Levy: It’s at FDA discretion. The FDA holds the deciding authority, and we are advisory to the FDA. The FDA decides whether to convene us, and I would welcome the opportunity, as a pediatrician and somebody who studies precision vaccines.

Gazette: What’s your sense of the need for this vaccine for children at this moment in the pandemic?

Levy: This would be important. We have continued coronavirus transmission in the United States. This pandemic is not over. Kids are getting back to school, and there’s transmission happening between kids, and between children and others. If indeed we have a safe and effective tool to reduce the risk of infection, and possibly transmission and illness from coronavirus in children, that would be a huge win for children and for the rest of society.

Gazette: Do you expect, in the future, for this or another COVID vaccine to be among kids’ routine vaccinations when they’re young. Is that the direction we’re headed?

Levy: The further forward we project, the less certainty there is around the projection. We’d love to reach herd immunity, but it’s possible that we won’t. It’s possible that this becomes an endemic virus that circulates mostly in winter. And then it’s possible that down the line, this becomes part of the pediatric vaccine schedule, but that’s getting quite a bit ahead of ourselves here. We’d like to look at the safety and efficacy for this current study.

Gazette: If the number of kids who get this vaccine mirrors the number of adults who have gotten the adult dose, with low vaccination rates in some areas, is that potentially a problem?

Levy: Any safe and effective vaccine is welcome, and if Americans who couldn’t get vaccinated before now can get vaccinated, that can only be a positive. What will the uptake be? Will it be 10 percent, 50 percent, 90 percent? The higher the uptake, the more benefit we will see as a society, but it would be a win in any case.

Gazette: So even a little bit would be better than what we have now?

Levy: The immediate goal here would be to determine safety and efficacy. If it’s there and the FDA moves forward, then the hope is for a very high percentage of Americans — of all these ages for which there’s an authorized or approved product — to receive the vaccine. That’s how we’re going to make the most headway against the pandemic.

Gazette: How fast could these doses potentially be in kids’ arms?

Levy: I have no insider information here, but from what I’m reading, the FDA might need a month to look at this data. So, let’s say we’re at Oct. 20. If they announce that they want a meeting of the advisory committee, it could be end of October, then a decision by FDA in November and then the CDC by the first, second week of November. So it could be rolling out in mid-to-late November, I’m guessing.

Gazette: So there’s a lot of wiggle room in that process?

Levy: Yes, by plus or minus two weeks.

Gazette: Do you have any message to parents who are reading this news?

Levy: I think they should stay tuned. They should understand that rigorous studies that are placebo controlled are being done in children at different dosing levels to really understand the safety and efficacy of these vaccines in children of younger and younger ages. And they should realize that we do have a robust process at the U.S. Food and Drug Administration to evaluate, in a transparent way, safety and efficacy. We take that seriously. So stay tuned and follow the public guidance.

As the baby boomer generation moves into retirement age, it is expected that by the year 2034, older adults (ages 65 and up) will outnumber children in the United States for the first time in history. As the population ages, demand for health care will increase, and rising rates of alcohol use in older adults may create additional challenges to an already burdened health care system.

Trends in alcohol use in older adults

Alcohol use in older adults has been trending upward over the years, particularly among women. One epidemiologic survey determined that in the United States between 2001 and 2013, among people 65 and older, the rate of alcohol use disorder increased 107 percent. The University of Michigan’s 2021 National Poll on Healthy Aging found that although the majority of older adults surveyed were drinking alcohol at low to moderate levels, there was a subset of older adults exceeding the recommended guidelines for alcohol use. In particular, 20 percent of respondents drank alcohol four or more times per week; 27 percent reported having six or more drinks on at least one occasion in the past year; and 7 percent reported alcohol-related blackouts.

Negative effects of alcohol use in older adults

Drinking too much alcohol can have negative physical and mental health consequences, including heart and liver problems, memory issues, mood disorders, as well as an increased risk of cancer and a weakened immune system. In addition, age-related changes in the body place older adults who drink alcohol at additional risk.

This is an excerpt from an article that appears on the Harvard Health Publishing website.

To read the full story

Dawn E. Sugarman is an assistant professor in the department of psychiatry at Harvard Medical School, and a research psychologist at McLean Hospital in the division of alcohol, drugs, and addiction. Shelly F. Greenfield is a professor of psychiatry at Harvard Medical School, and the Kristine M. Trustey Endowed Chair of Psychiatry at McLean Hospital.

Experts are working out a broad strategy to vaccinate Americans, with an eventual plan likely to prioritize health care and essential workers, as well as the vulnerable elderly and those with risk factors for severe disease.

Even with a strategy in place, however, the devil will very likely be in the myriad details if it is to be a success, experts said. For example, even if initial distribution is limited just to health care workers alone, that’s not an inconsiderable cohort: There are 20 million of them. If you want to add essential workers that’s another 60 million. In addition, even minor side effects that mirror the disease will sideline those who have to report that they are symptom-free before coming to work each day. That means, for example, a campaign that inoculates an entire intensive care unit’s workforce on the same day could have disastrous consequences if a significant number report symptoms the next day and can’t come to work.

Those examples, offered by Rochelle Walensky, chief of Massachusetts General Hospital’s Division of Infectious Diseases and a professor at Harvard Medical School, represent just some of the potential hurdles to be overcome in a vaccine rollout that promises to be not only vast, but also vastly complicated. However, experts said Friday that the vaccine rollout presents another opportunity to get the fight against the coronavirus right, despite the nation’s failure to take steps needed to prevent infection on a massive scale.

“I am struck by the challenges that we have ahead of us in thinking about rollout,” said Sarah Fortune, chair of the Department of Immunology and Infectious Diseases at the Harvard T.H. Chan School of Public Health, who appeared on a recent online panel with Walensky. “We, as a society, have not done necessarily the best job in terms of getting our prevention measures in place, our response measures in place, and now we face an enormous challenge but an enormous opportunity to get this next phase right.”

Panelists gave high marks for recently released early results of Phase 3 vaccine trials, saying the work has been conducted to high scientific standards, and the efficacy rates of 90 percent for the preventative from Pfizer, which applied for an FDA emergency use authorization on Friday, and 94.5 percent from one by Moderna Inc. are not only encouraging, but better than they had hoped. (AstraZeneca also reported early numbers on Monday, with effectiveness of up to 90 percent, depending on dosage.) That, together with reports of relatively minor side effects, makes experts optimistic that these and other vaccines may represent a light at the end of the pandemic tunnel.

But that light is still a way off, panelists cautioned. The Pfizer and Moderna vaccines have a couple of drawbacks: Both have to be stored in cold temperatures — the Pfizer vaccine at minus 70 degrees Fahrenheit, and Moderna’s at minus 20 — and both also require two doses to be effective. Those characteristics not only mean that regions with the equipment to handle the storage demands — urban areas — are likelier to get the vaccines first, but also that any vaccine education campaign should emphasize that people can’t abandon public health precautions after the first shot because they won’t be immune until shortly after their second shot, some five or six weeks later. Complicating all of that, Walensky said, is the fact that 25 percent of Americans don’t have a primary care doctor, the normal administrant of things like vaccinations.

“The day you get your vaccine is not the day you take off your mask,” Walensky said. “We’ll be in a much better place once the population is vaccinated, but we won’t be without masks for a while.”

Vaccines being tested by AstraZeneca and Johnson & Johnson were created by more traditional means than the messenger RNA preventatives of Pfizer and Moderna. Depending on the final outcome of those still-ongoing Phase 3 trials, those treatments will likely be more forgiving with regard to storage and have differing efficacy and side effects, which may make them better suited to distribution in parts of the country distant from minus 70-degree freezers.

Walensky and Fortune were joined by Barry Bloom, the Joan L. and Julius H. Jacobson Research Professor of Public Health, and epidemiology Professor Marc Lipsitch, who heads the Chan School’s Center for Communicable Disease Dynamics, at a Facebook Live event on Friday that was sponsored by The Forum at Harvard T.H. Chan School of Public Health and NPR.

In the next six months, it’s likely that every American will be vaccinated, recovered from coronavirus infection, or both. If that happens, cases and deaths could decline, and the pandemic could start to fade.

That’s what William Hanage predicted in a Thursday evening seminar titled “COVID-19: What we’ve learned about the pandemic and what we keep forgetting.” In his talk, Hanage, an associate professor of epidemiology at the Harvard T.H. Chan School of Public Health and faculty member of the Center for Communicable Disease Dynamics, offered an optimistic outlook, predicting no significant winter surge and a steady drop in cases through March 2022. But, he said, the pandemic will wane only if the country learns from past mistakes, remains cautious, and relies on more interventions than just the vaccine. And, of course, if no new superspreading variant capable of breakthrough infections arises.

“Things could be relatively good, or they could not be,” he said.

Hanage uses both theoretical and laboratory work to track and predict the evolution of various infectious diseases. Since February 2020, he and other epidemiologists have used mathematical modeling to try to anticipate how COVID-19 might spread across the globe. Possible scenarios range from a single, controlled outbreak to an uncontrolled pandemic. Which way the world tips depends on two major factors: how infectious people are before they develop symptoms, and what measures countries use to control outbreaks.

As of February 2020, scientists already knew people carrying the virus were infectious before developing symptoms and that certain now-ubiquitous interventions — social distancing, wearing masks, washing hands — could help prevent the spread.

“It is remarkable how much we’ve forgot — it’s staggering,” Hanage said. “But we’ve also learned a lot.” The problem is, he continued, “Now we know and still do nothing.”

In early 2020, COVID-19-associated mortality correlated with crowding and population density, Hanage said. But by the time record cases and deaths swept through the Sun Belt between September 2020 and February 2021, causing 54 percent of the now nearly 700,000 total deaths in the U.S., those top correlations shifted. Although nursing homes remained the single biggest predictor of mortality, the second biggest was political leaning: Republican-run states, many of which enacted fewer control strategies, experienced the most devastating surges.

Today, those same states still resist the same tactics that might have prevented those surges, said Hanage, citing recent headlines such as the one that ran in Vanity Fair: “Mississippi Governor Announces Bold Plan to Do Nothing to Stop COVID.” As of September, Mississippi has the highest rate of deaths, with about one in every 320 succumbing to the virus.

Harvard Medical School scientists report they have successfully restored vision in mice by turning back the clock on aged eye cells in the retina to recapture youthful gene function.

The team’s work, described Dec. 2 in the publication Nature, represents the first demonstration that it may be possible to safely reprogram complex tissues, such as the nerve cells of the eye, to an earlier age.

In addition to resetting the cells’ aging clock, the researchers successfully reversed vision loss in animals with a condition mimicking human glaucoma, a leading cause of blindness around the world.

The achievement represents the first successful attempt to reverse glaucoma-induced vision loss, rather than merely stem its progression, the team said.

If replicated through further studies, the approach could pave the way for therapies to promote tissue repair across various organs and reverse aging and age-related diseases in humans.

“Our study demonstrates that it’s possible to safely reverse the age of complex tissues such as the retina and restore its youthful biological function,” said senior author David Sinclair, professor of genetics in the Blavatnik Institute at Harvard Medical School, co-director of the Paul F. Glenn Center for Biology of Aging Research at HMS and an expert on aging.

Sinclair and colleagues caution that the findings remain to be replicated in further studies, including in different animal models, before any human experiments. Nonetheless, they add, the results offer a proof of concept and a pathway to designing treatments for a range of age-related human diseases.

“If affirmed through further studies, these findings could be transformative for the care of age-related vision diseases like glaucoma and to the fields of biology and medical therapeutics for disease at large,” Sinclair said.

For their work, the team used an adeno-associated virus (AAV) as a vehicle to deliver into the retinas of mice three youth-restoring genes — Oct4, Sox2, and Klf4 — that are normally switched on during embryonic development. The three genes, together with a fourth one, which was not used in this work, are collectively known as Yamanaka factors.

The treatment had multiple beneficial effects on the eye. First, it promoted nerve regeneration following optic-nerve injury in mice with damaged optic nerves. Second, it reversed vision loss in animals with a condition mimicking human glaucoma. And third, it reversed vision loss in aging animals without glaucoma.

The team’s approach is based on a new theory about why we age. Most cells in the body contain the same DNA molecules but have widely diverse functions. To achieve this degree of specialization, these cells must read only genes specific to their type. This regulatory function is the purview of the epigenome, a system of turning genes on and off in specific patterns without altering the basic underlying DNA sequence of the gene.

This theory postulates that changes to the epigenome over time cause cells to read the wrong genes and malfunction — giving rise to diseases of aging. One of the most important changes to the epigenome is DNA methylation, a process by which methyl groups are tacked onto DNA. Patterns of DNA methylation are laid down during embryonic development to produce the various cell types. Over time, youthful patterns of DNA methylation are lost, and genes inside cells that should be switched on get turned off and vice versa, resulting in impaired cellular function. Some of these DNA methylation changes are predictable and have been used to determine the biologic age of a cell or tissue.

Yet, whether DNA methylation drives age-related changes inside cells has remained unclear. In the current study, the researchers hypothesized that if DNA methylation does, indeed, control aging, then erasing some of its footprints might reverse the age of cells inside living organisms and restore them to their earlier, more youthful state.

Past work had achieved this feat in cells grown in laboratory dishes but fell short of demonstrating the effect in living organisms.

The new findings demonstrate that the approach could be used in animals as well.

Overcoming an important hurdle

Lead study author, Yuancheng Lu, research fellow in genetics at HMS and a former doctoral student in Sinclair’s lab, developed a gene therapy that could safely reverse the age of cells in a living animal.

A Harvard infectious diseases expert says that vaccination rates among the elderly need to be close to 100 percent if another surge of COVID-related hospitalizations and deaths is to be avoided this winter.

Stephen Kissler, a research fellow at the Harvard T.H. Chan School of Public Health, said the strongest factor in COVID severity is the proportion of elderly who are vaccinated. He pointed to Florida, one of the states hardest hit by the summertime delta surge, and the U.K., whose early experience with the variant was not as severe as Florida’s. The difference, Kissler said, appears to be that vaccination rates of the elderly, while relatively high in Florida compared with surrounding states, did not approach U.K. levels.

“Florida was high, but not extremely high,” said Kissler, whose research involves modeling the spread of infectious disease. “Even 5 percent shy of 100 — if 95 percent of those age groups are vaccinated — that remaining 5 percent can still contribute a lot to severe disease and death. We really need near 100 percent vaccination rates in those older age groups.”

More broadly, Kissler expects the summertime surge across the South to shift north as the weather cools and people move inside. Though vaccination rates in some northern states are relatively high, delta is infectious enough that the remaining pool of unvaccinated people, coupled with those whose immunity has waned over time, could fuel a winter surge, he said. On top of that, seasonal effects will boost transmission.

“What I expect is that, especially in places that were largely spared from a major summer surge — so especially the more northern parts of the country — are almost certainly going to see another significant winter wave,” Kissler said.

Those surges, he said, will vary from place to place, depending on local immunity levels, but some regions will be hit hard enough to fill hospitals and force delays in elective surgeries. Communities hit hardest will be those with low vaccination rates that haven’t yet seen a delta surge.

“I do still think this winter will probably see, in some parts of the country, similar scenarios to what we saw in parts of the southeastern U.S. this summer, where in some regions hospitals will be very full, we’ll have to put elective surgeries on hold,” Kissler said. “I think those surges will probably be geographically more isolated, since there are different degrees of immunity across the country, but there are still going to be some communities hit pretty hard this winter. I think that’s something we have to be very clear-eyed about moving forward.”

Kissler, who took questions Wednesday during a media conference call, added that it’s possible that this year’s flu season will be worse than last year’s, when, protected by anti-COVID measures such as masks and distancing, the U.S. largely avoided widespread infection. Easing those practices will create fertile ground for illness, he said, noting the heightened importance of flu shots.

With the winter behind us, COVID-19 is likely to follow the path of the 1918 flu and the 2009 H1N1 flu, Kissler said, becoming a milder seasonal affliction, circulating mainly in winter in a population that is largely vaccinated or previously infected.

“My hope is that once we get through this winter wave, we’ll start to enter into a phase of the pandemic where SARS-CoV-2 is more of a seasonal respiratory virus than this incredibly disruptive pandemic virus that we’ve been dealing with,” Kissler said. “We still have a little work left to do, but my hope is that we’re approaching something that is ever closer to normalcy.”

Public health officials have warned for months of the possibility of a serious post-Thanksgiving surge in COVID-19 cases. If it does happen, a Harvard epidemiologist says, the signs should become apparent this week, and she cautioned those who gathered with family and friends for the holiday to get tested or act under the assumption that they’ve been infected.

“We expect a rise in cases and a rise in deaths, unfortunately, over the next few weeks,” said Megan Murray, professor of epidemiology at the Harvard T.H. Chan School of Public Health and the Ronda Stryker and William Johnston Professor of Global Health at Harvard Medical School. “The main thing is to recognize that you could have been exposed and to assume you’re exposed — or test frequently. Assume one might be infectious rather than otherwise.”

Murray, who offered her prediction on Tuesday during a Facebook Live event sponsored by The Forum at Harvard T.H. Chan School of Public Health and PRI’s “The World,” balanced the dismal outlook for the immediate future with the likelihood that vaccine distribution could begin later this month. If the FDA approves the vaccine developed by Pfizer and Germany-based BioNTech — a step taken Wednesday by British authorities — distribution could begin very quickly, she said.

Infectious disease experts and epidemiologists tracking the coronavirus have warned that holiday gatherings have the potential to fuel virus transmission and boost an ongoing national surge that has seen 1.1 million new cases over the last seven days alone and pushed total deaths above 267,000. Those numbers, which continue to climb, have prompted dire predictions for the coming months, even as hope for an eventual end to the pandemic has risen with the apparent success of coronavirus vaccines.

Despite the mounting good news on vaccines, Murray said their distribution faces considerable hurdles, including such practical matters as how to store vaccines that need very cold temperatures in locales without the necessary equipment. Other issues include deciding who should be vaccinated first. States will have a significant say on this question, and the Centers for Disease Control and Prevention advisory board this week advised that front-line health care workers and vulnerable elderly should be first in line. Another issue, Murray said, is whether enough people are willing to be vaccinated to interrupt transmission. If just 50 percent of the population lines up, it would be “a real problem,” she said.

“It’s not easy, but it’s doable,” Murray said.

Murray gave the clinical trials high marks for scientific quality but pointed out that trials of such short duration don’t give researchers a sense of a vaccine’s characteristics over the long term, including how durable immunity will be.

Public health officials have likewise noted that it is also unclear whether it’s possible to carry the disease and infect others even if you are immunized.

It’s likely that a vaccine won’t be widely available for months, Murray said, and in the interim people are left to continue to deal with the daily reality of the pandemic. There is a new tool to help, however. An at-home test by Lucira Health Inc. is the first that provides results without having to send a sample to a lab. While the new test represents progress in the march toward rapid and frequent at-home testing — which has been suggested as a way to interrupt transmission and control the pandemic — Murray said because this test is only available by prescription and costs $50, it may be too pricey to be the answer for daily or weekly testing.

Overall, the testing landscape is “chaos,” Murray said, marred by inconsistencies where some get tested immediately and see results quickly, while others wait in long lines for tests and results take days. The situation, she said, illustrates a lack of public health governance.Will there be a serious post-Thanksgiving COVID surge?

“It can be done; it just hasn’t been done,” Murray said of a fair and fluid testing scheme.

Nobody was prepared for 2020, but a public talk on collective trauma in December 2019 was prescient. At Harvard Medical School’s live-streamed “Talk@12,” Bala Subramaniam, Ellison “Jeep” Pierce Associate Professor of Anesthesia, engaged in a conversation with Thomas Hübl, author and founder of the nonprofit The Pocket Project, which educates the public on the impact of collective traumas and trains professionals to facilitate events focused on healing. For the past 18 years, Hübl has helped hundreds of thousands of people spark dialogue and work toward restoring some of humanity’s worst transgressions. Since April, Hübl has been offering workshops to Harvard faculty and staff to help them meet the challenges of the COVID-19 pandemic. The next three-part series, “Mindfulness in Action: Leading & Communicating During Challenging Times,” offered through the Harvard Longwood Campus Office of Employee Development & Wellness, will begin on Jan. 26, 2021.

Q&A

Thomas Hübl

GAZETTE: Most of us would agree we are currently living in a time of collective trauma. What are your thoughts on how we should be thinking about what we are facing?

HÜBL: First I’d love to talk about collective trauma as traumatic events that a bigger part of a population, a nation, or the world, goes through collectively. This results in individual traumatizations or difficulties, but also, there is a shared cultural space, I believe, that we need to take into account. So often trauma is seen as a personal issue, and now we are talking about the collective or systemic dimensions. There are two phenomena: a very stressful current situation, like COVID-19, or the climate crisis, which is already intensifying. But these events meet in all of our shared history, which I refer to as the unintegrated parts of our shared past. That shared past is, in a way, like the sand in the engine in how we respond to the current crisis. I believe when we talk about collective trauma, we’re usually talking about the root causes that lead up to the current crises and the way we respond to a current crisis. They’re entangled.

GAZETTE: What are the effects of all these interconnected traumas on people?

HÜBL: When we look at a trauma there are two major sets of symptoms: One is hyperactivity, which comes with a tremendous amount of stress and reactivity, and the other one is numbness and indifference. So trauma comes with the underlying sense that we are separate, at least at times. And the more stress, which comes with two or three adversities in the system, the more trauma becomes intensified.

Integrated history is presence and unintegrated history is the past. When I refer to the past in this way, I mean the emotions, thoughts, and body sensations that overshadow my current experience. So how can we together create environments that help us to be truly present and relate more meaningfully to support our mutual past so it can become integrated into the present?

GAZETTE: I met you in 2017 when you came to speak at the MIT Innovation Center in Boston. You said then, “The Holocaust sits in the room with us right now.” And I couldn’t really say I heard that before or could really understand exactly how it sat, but I felt the truth in that. I wonder if you could say more.

HÜBL: I often say trauma is taking a loan from our own future. This means when I’m in traumatic situations, I’m so overwhelmed that I numb a part of myself to survive. So the trauma response is a very intelligent function within us, within our nervous systems, but there is a price. We need to pay back that debt along with interest, so to speak. In the last decades, the notion of trauma has become public knowledge, but it’s also important to learn about the attachment stress that hasn’t been integrated in children who have been neglected or abused. That adversity is still living deep in their bodies as adults. We just don’t know about it because it became so normal. So I might say “That’s me.” But it’s not me. That’s me in a hurt place. It’s very important to name it.

The same is true for millions of people who were in concentration camps and needed to dissociate. Some of the atrocities I’ve heard that people have survived are heartbreaking and unbelievable. People can survive those situations only heavily dissociated. But all that suppressed and fragmented information doesn’t disappear, and I think we are seeing more and more the transgenerational transmission of trauma.

In my work over the past 18 years, I’ve seen that whenever we touch the collective denial in a group and we meet the collective unconscious, so to speak, everyone in the room can sense this in their bodies and in the stress present in the room. After, we have seen the denial turn into a kind of release. I’ve observed that this form of denial can live in our nervous systems 24/7. We just aren’t aware of this because the focus of our consciousness is somewhere else.

GAZETTE: You said one of the symptoms of collective trauma is a chronic level of dissociation or numbness. Can you speak more about this?

HÜBL: First, it starts with honoring and respecting the function of dissociation and an appreciation of the capacity of the nervous system to dissociate from overwhelming experiences. Dissociation and overwhelm for a 2-month-old baby are completely different than for a 30-year-old. I think it’s very important that we don’t measure overwhelm just by what’s overwhelming to us. Overwhelm has many different flavors.

For example, when I read the news, how much can I really take in? I think that more often than not, we see things like wars or racist actions and it’s so hard to stay with it and feel what it means, what’s happening to the person, what’s happening in our society. So we might decide it’s better to be absent and only cognitively informed, rather than allowing ourselves to truly feel.

GAZETTE: In your book “Healing Collective Trauma: A Process for Integrating Our Intergenerational and Cultural Wounds,” you discuss the process that you do with groups. How does it work?

HÜBL: The process works on the principle that individual or systemic coherence is the power to integrate the fragmentation of the system. And sometimes the system doesn’t have enough inner coherence. So then we need to build this through group processes. And we need to supplement — just as a trauma therapist might do for a client — the missing element. We need an infusion of coherence into the group to integrate with the traumatization, which can lead to inner stability and structure, and help them develop a more fluid way to respond to the world. We have had many groups that focused on the Second World War and the Holocaust legacy in Germany and Israel. And then we expanded the topics to include colonialism, gender traumatization, racism in the U.S., and others.

GAZETTE: What kind of enthusiasm and perspective does one need to engage in such a challenging and heavy topic?

HÜBL: At first, the topic of collective trauma appears heavy, and this is because we are dealing with the major ethical catastrophes on this planet. But underneath trauma there’s always healing, which means an ethical restoration and ethical upgrade. Post-traumatic growth is an ethical realignment.

There have been uncountable genocides and wars, and all kinds of transgressions. When we come to the place of restoration, there’s a kind of illumination, a self-healing mechanism that heals the tissue of life. And I believe that collective healing will support individual healing and help us learn even more about individual health. We will see these two systems as unified, as they are. The collective and individual are not separate. They work as an interdependent system.

This conversation has been edited and condensed.