Dr. Gerald Keusch is a professor of medicine and international health at Boston University, and the director of the Collaborative Research Core at BU’s National Emerging Infectious Disease Laboratory. He answered your questions back in April, and joined us again to discuss masking orders, school reopening, and the politicization of science.

The conversation has been lightly edited for length and clarity. 

Ohio Valley ReSource: Thank you for joining us. To start with, are thoroughly-followed mask orders enough on their own? Or do they need to be combined with other measures, like contact tracing, in order to get the job done?

Dr. Gerald Keusch: Just today (Thursday), two things appeared in the Journal of the American Medical Association. One was a brief report from two of the major academic medical centers in Boston. In March, as cases were really taking off here, Massachusetts General Hospital And Brigham and Women’s Center implemented a mandatory mask order for everyone in those two institutions. And then they tracked what happened. And what they saw was, within 10 days, the rates of infection dropped. This was accompanied by an editorial, which said that the research clearly shows that even in a high-intensity setting like a hospital, masks alone have a significant impact.

Now, there’s been a lot of discussion: Are these masks simply altruistic? Are you just reducing your delivery of particles out into the environment? Or are you also protecting yourself by wearing one? We now can say that it’s both. And it’s so simple, so easy to use.

But it doesn’t take much to figure out why we’ve seen so much resistance to the use of masks. We have failed, at the highest levels of this government, to impose a common message. We have diminished the reliability of information, and we’ve empowered people who don’t know what they’re talking about, like economic advisors to the president, to capture the agenda among some portion of our population.

So there’s no question in my mind that the universal use of masks in public spaces is an effective, simple, cheap behavioral tool. This is totally separate from the value of contact tracing and spacing, both things that are relatively easy to do and were neglected during our initial reopening. The problem is that, like everything on the public health side, we’re unprepared to do it effectively. These measures are all interconnected, and they all need to be in place to get this under control.

OVR: In the Ohio Valley, we’ve seen a lot of different approaches to enforcing mask orders, whether it’s businesses or local health departments taking that on, with varying success. What are some best practices when it comes to enforcing these kinds of public health measures?

GK: You’ve hit on some of the key problems here. Should the police spend their time enforcing them? We’ve seen the consequences, at least in Michigan, of businesses trying to do that. I think the problem is that our messaging to the public has been scattered. There’s no shared message about responsibility.

This is not arbitrary; this is not to limit one’s rights. This is because it works. It protects you and it protects others, and there’s a moral responsibility to your community to do this one thing.

OVR: Cases are rising around the country. We’re seeing more mask orders, we’re seeing more signage around social distancing and we’re doing more testing… but is that enough? Is there a certain tipping point where we need to go back to a full lock down or stay-at-home order?

GK: Those more draconian measures clearly worked. But they’re not sustainable. We would be in better shape now, following that period of major interruption in society and economic life, if there were leadership at the federal level, and if all of the states had a similar kind of pathway that was slow and measured.

What do we do now? It’s hard to say we have to go back to total isolation and economic shutdown. But that might need to happen in states where the governors went ahead and opened too soon. Their residents will suffer more than those in states that took the shutdown seriously.

OVR: One thing that’s really on people’s minds right now is school reopening. And it seems that there are different calculations for elementary and high schools versus colleges and universities. So let’s start with college. Someplace like a Harvard, where you are in the Boston area, might have the resources to do really thorough testing. But other schools, community colleges, places that serve a lot of low-income or nontraditional students, may not have those resources. How should school administrators be thinking about reopening given that diversity of resources and needs?

GK: You’re quite right. And it brings us back to the role of the federal government. They’re the only ones with the resources to close that gap. These are national issues, and that’s where public support needs to come in. We should be a reasonable, concerned society, and unfortunately, we don’t seem to be.

OVR: Let’s switch to elementary and high schools. Where are you right now on the idea of school opening?

GK: In part, it’s a matter of resources. It’s also a matter of rational thinking, and resolve. But I think the best approach is to prioritize kids with disabilities and special needs, because virtual learning may be impossible for them. That’s a special population that we really want to get back into the classroom.

There’s a new report from the National Academy of Sciences, Engineering and Medicine that says that in-person learning is really important for the youngest of the school population. It’s also the hardest to deal with in terms of social distancing and use of masks. But if you’re going to start anywhere, those are the places to start.

Then you get into measures like distances between desks, cohorting them so they don’t mingle in cafeterias. You also have to consider access to technology and reliable internet for a lower-income population. That’s going to be a major factor in the Ohio Valley region.

There is no firm yes or no when it comes to school reopening. It’s all about, can you do it right?

OVR: In your time working in infectious disease research, I’m sure you’ve thought a lot about what a major pandemic would look like. Now we’re in one. What did you think it would be like, and how does that compare to the reality we’re living through?

GK: The thinking has always been that the global pandemic that we all feared was not going to be an Ebola kind of disease or something like a Zika. Zika had some really significant consequences on developing brains, but for the vast majority of people, it was asymptomatic.

The worst-case scenario was going to be in influenza-like disease. It would be respiratory-transmitted, with a range of symptoms from asymptomatic but still infectious, to the severity of hospitalization, ICU, ventilators, and high mortality.

So it’s the influenza model that people feared the most, and the really astute researchers knew that it was going to be a coronavirus.

Because of that assessment, the National Institutes for Health, with the involvement of Dr. Tony Fauci, decided that it would be wise to put a good deal of its money into research around a vaccine for some type of coronavirus. That turned out to be a very wise decision, because it’s set us up to develop a vaccine more quickly than we might have otherwise.

OVR: Do you know Dr. Fauci?

GK: Yes. We shared a mentor, and we’ve had parallel careers. We’ve interacted over decades.

OVR: How do you think he’s doing, on a personal level, with the public spotlight he’s in right now,and all the responsibility on his shoulders?

GK: He and I both grew up in Brooklyn, New York. You gotta be tough to grow up in Brooklyn.

Rand Paul is one of your senators in Kentucky, right?

OVR: Yeah.

GK: Rand Paul went off on a rant when Fauci was testifying before the Senate. That was the most unintelligent stream of consciousness that I have ever witnessed.

OVR: Have you seen previous public health crises be politicized the way this one is?

GK: No. Not from this high up in the government. There’s something systematic going on to prevent disastrous information from coming out which could be harmful to the president’s campaign to win the election in November.

But it goes beyond this administration. Public health is one of the most essential endeavors in a society, but when it works the best, people don’t notice it, because disaster is averted. So people say, ‘Why are we spending so much money when nothing is happening?’ The money gets cut, a disaster happens, and then the public health establishment gets blamed for it.

In this country more than others, we have underfunded an infrastructure that is an essential component of a healthy society.

When it comes to the skepticism of science and of expertise in this country, particularly on the right, it goes much farther back. We have underfunded education for decades. There’s been a long, systematic under-investment in fundamental institutions that are necessary for a successful society, and now we’re dealing with the consequences of that.

OVR: Dr. Keusch, thank you for speaking with us.

GK: My pleasure.