Pandemic in hindsight: Lessons learned as COVID-19 turns 5

Another focus for Tierney in those early days of the crisis was on keeping the state medical community informed through webinar updates she held three times a week. That reinforced for her a tenet of public communication: “If you don’t know, say you don’t know.”

“People whose job it is to communicate public health need to never overreach in terms of what they’re communicating,” she says. “You have to protect credibility.” 

From a scientific standpoint, Tierney says, a major pandemic takeaway is the successful use of messenger ribonucleic acid (mRNA) — technology that had already been in the works for years — for rapid development of the vaccines that would protect so many against the emergent COVID-19.

“Had mRNA technology not been where it was, there’s no way the vaccine would have been developed that quickly.”

And that, she says, underscores a broader lesson: the vital importance of ongoing scientific study.

“The continual study of vaccine science, how to prevent illness, is absolutely key,” says Tierney, who in 2020 was awarded the inaugural McKnight Prize for Health Outbreak Heroes. “We don’t know exactly what the next virus is going to be, but we have to be ready.”

As for the COVID-19 virus, “It’s with us forever,” she says. “It’s endemic. We’ll probably have twice-a-year peaks, in the summer and late winter.”

Which, she says, makes continued vaccination so important — at a time when there is decreasing confidence in vaccination in general. The decrease in vaccination rates are resulting in increases of pertussis and measles nationwide.

“How to get public confidence back about vaccination is, to me, the most immediate call for public health,” Tierney says. “What are the two most important things that have led to improvements in health and life expectancy? It’s clean water and vaccination.”

Christopher Destache, PharmD’84
Professor of Pharmacy

The pandemic evokes for Destache memories of healthcare providers working together “with the common goal of protecting patients and protecting each other.”

That early camaraderie and common feeling of purpose gave way, for many, to burnout.

“That was particularly true for the ICU nurses and physicians,” Destache says. “And so, because of the pandemic, we’ve since seen a dramatic reduction in ICU nurses.”

The main lesson learned, he says, is that public health systems must be upgraded to keep track of serious, life-threatening viruses — wherever in the world they may originate.

“It’s a big lost art,” he says. “All public health comes from the federal government, so it’s important for them to understand that if we don’t track these viruses worldwide, we’re going to be late to the party.”

Resources, or lack thereof, play an outsized role in the ongoing fight against novel viruses, Destache says. “The CDC is always looking at what’s out there, but the number of investigators who can look at an outbreak is somewhat limited because of funding.”

Another lesson learned, he says, is the role of misinformation, particularly on social media. 

“There was a lot of misinformation, and a lot of people who followed that misinformation, to their detriment,”  Destache says. “We still have some of that, but I think it’s gone down quite a bit.

“On social media, so many people are considered experts because they have a following,” he says. “You have to really think hard before you start posting, particularly if you are a leader — political, national or the leader of an organization — because you’re going to have followers, and you’ve got people who are panicking, and they want some guidance. 

“It’s really important to get your facts straight.”

Anne Mardis O’Keefe, MD, MPH
Vice Chair, Public Health

As the senior epidemiologist for the Douglas County (Nebraska) Health Department from 2006 to 2022, prior to her arrival at Creighton’s School of Medicine, O’Keefe is keenly aware of the importance of accurate communication during a public health crisis. Her role at Douglas County included communicating and coordinating with healthcare providers and the public during disease outbreaks, including COVID-19.

That work drove home huge lessons.

“If you lose trust early, it’s really hard to get it back,” she says. “The rule is ‘be first, be right, be credible.’ If you’re not the first out there, others will get that credibility.”

COVID-19, she says, was novel in more ways than one. It marked the modern advent of “health as a political weapon.” Because of federal politics, the CDC didn’t have the resources it needed to properly lead the pandemic response, she says. So, much of that task was left to state and local agencies.

In the pandemic’s early days, O’Keefe says, “We had to figure it out ourselves. And we had to be out there communicating. ‘How big is it? Is it here yet? How ill are people getting, and who’s getting killed by it?’ (In the absence of federal guidance) we had to find out that information locally.”

Today, she says, COVID-19 is still prevalent, but most of the population has either had the disease or been vaccinated. However, that doesn’t mean the threat is gone.

“It’s still killing people,” she says. “It’s worse than flu. Babies who were born after the pandemic have no immunity.”

Just as worrisome is the lingering political dynamic, O’Keefe says. “There’s still this idea that vaccines are killing people, when it’s actually COVID that’s killing people. And global politics still hinder pandemic response. We’re vulnerable to these information wars.”

That’s had a chilling effect on dialogue about the disease, she says. 

“People don’t want to talk about COVID. Health departments are afraid to talk about it, because they got so much hate.”

On the positive side, O’Keefe points to several scientific advancements as fruit borne from the pandemic.

“We’ve bounded forward. We were able to speed up clinical trials and reduce barriers. And mRNA technology can now be used for other diseases,” she says.

“Another big thing that came out of it was wastewater testing,” she adds. “It’s the best way to know what’s happening in the community.”

Zachary DePew, MD’07
Division Chief and Medical Director, Pulmonary, Critical Care and Sleep Medicine

DePew’s pandemic takeaways largely center on preparedness. He remembers talking with colleagues about COVID-19 just as it was hitting the U.S. coasts and speculating about what it might look like as it spread across the country.

“I don’t think we were accounting for volume,” he says. “The volume and severity of illness, and just how overwhelmed the whole system was.”

He remembers, too, how quickly overtaxed the hospitals became in the early months, both in terms of available beds and medical supplies.

“I never thought I’d show up to work one day and be without basic equipment and supplies,” DePew says.

That experience made for a practical pandemic lesson: “Don’t even take the basics for granted. Don’t assume limitless supplies, even of simple things, like masks and gowns.”

“Remember, a million Americans died,” he says. “That’s about one in every 400 people. It did a number on our population. If we find ourselves in another big crisis, we learned we don’t have the bandwidth to absorb it.”

Beyond healthcare capacity and preparedness, DePew says he was struck by how quickly the “tone of society” can change.

“I remember the summer of 2020, driving around on empty streets and seeing signs in tribute to ‘our healthcare heroes,’” he says. “But that tone changed rather abruptly.” 

Those “heroes” became objects of scorn, a turnabout stoked by politics and a breakdown in civility, he says.

“We started out thinking the pandemic was going to be a shorter-term thing — ‘We can get through this in a matter of weeks or months.’ Then it was years. Then it got into politics,” he says. “Healthcare really has nothing to do with politics.”

As for the virus itself: “The overwhelming majority of people have either been vaccinated or had the virus, which is why we’re not seeing as much severe disease,” DePew says. “But COVID’s not gone. It’s still there. And now we’ve seen a swell on the back end.”

The lesson for all of us? “Try to stay healthy,” he says. “As much as you can.”

Rev. Kevin FitzGerald, SJ, PhD, PhD
Chair, Department of Medical Humanities

Reflecting on the dire days of the pandemic, Fr. FitzGerald remembers first the resiliency of Creighton students.

“It was amazing how our students handled it,” he says. “They rolled with the punches, and they wanted to get back in person. It’s one of the things that made me grateful to be here. They said, ‘OK, what do we have to do to continue our education and make this work?’ They adapted. We all adapted.”

Getting back in person wasn’t readily possible, of course.

“The pandemic really separated people, which is a horrible thing,” Fr. FitzGerald says. “But it also rapidly expanded our adeptness at being online.”

He acknowledges, too, the societal divisions exposed in a crisis like COVID-19 — divisions that are still coming to light.

“I’m not sure we’ve learned all the lessons yet. We’re still learning,” he says. “The biggest, which continues to evolve, are the lines of fracture that became apparent in society. The common good, doing things for others, being aware of how one’s actions impact others. 

“The pandemic really brought out some areas where people significantly disagree. ‘Am I my brother’s keeper?’ It became more about me, me, me. The different ways people responded to each other with aggression.”

Another aspect of the pandemic that people are still coming to grips with, Fr. FitzGerald says, is the balance between protecting physical and mental health.

“In a pandemic, the public health takes priority,” he says. “But were we understanding the impacts on certain vulnerable people, those with compromised immune systems vs. those impacted by isolation?” In the campus setting, for example, there were “people who can’t learn well via the internet, asynchronously. They were better in person.”

Like DePew, Fr. FitzGerald notes a societal shift toward aggression, a “darkness” that has since moderated, he adds — while acknowledging that it’s still unclear what exactly led to that aggression. Underneath it: an undeniable presence of fear.

“It’s interesting to see what fear did to our world and society,” he says. “It’s kind of shocking. You want to hope that, under extreme circumstances, people’s best selves will come out.”

Faith plays a part, too.

“Why do I continue to be hopeful and engaged? We belong to a Catholic community of well over a billion people. Christians account for over 2 billion. And if you consider all religions, that’s the vast majority of people on the planet,” Fr. FitzGerald says. “All religions’ values say that you cannot forget others. It’s not just about ‘me and my group.’ All religions work against that.”

Tracking COVID-19 Variants

Renuga Vivekanandan, MD, professor and associate dean for clinical affairs in the Creighton School of Medicine, and an infectious disease expert, was interviewed by Parade Magazine in October to discuss the rise of the new XEC COVID-19 variant. 

Vivekanandan, recently named vice president and chief medical officer for the Physician Enterprise at CHI Health, said that while the variant is still in the early stages of its spread, its presentation is similar to earlier strains: cough, fever and respiratory symptoms. 

The Centers for Disease Control and Prevention offers a COVID Data Tracker for the latest information on COVID-19 trends at covid.cdc.gov/covid-data-tracker.