Anupam Jena: What Are Some Less Obvious Ways COVID-19 Could Change Our Lives? Anupam Jena has made a practice of looking at big data and natural experiments to ask questions others overlook. He describes how the COVID-19 pandemic could have several unexpected consequences.
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Anupam Jena: What Are Some Less Obvious Ways COVID-19 Could Change Our Lives?

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Anupam Jena: What Are Some Less Obvious Ways COVID-19 Could Change Our Lives?

Anupam Jena: What Are Some Less Obvious Ways COVID-19 Could Change Our Lives?

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MANOUSH ZOMORODI, HOST:

It's the TED Radio Hour from NPR. I'm Manoush Zomorodi. On the show today - Inoculation, ideas about how we can protect and prepare ourselves for future pandemics. And we might get better at coming up with those ideas if we analyze human behavior in a more holistic way.

ANUPAM JENA: What drives me in most of my research is the question. I'm attracted to these kinds of questions that are all around us. These are experiences that we're all having.

ZOMORODI: This is Anupam Jena. He's a professor at Harvard Medical School. He's also a physician, an economist and what he calls a creative investigator.

JENA: I spend most of my time combining the tools of economics and medicine and thinking about applying the statistical tools that economists use - which are called natural experiments - to try to uncover interesting things about how humans behave, at least in health care.

ZOMORODI: So as a researcher, Anupam is observing how COVID-19 might change our lives in less obvious ways. For example...

JENA: In the few days where I was able to leave the house, the roads were - had much less traffic than they did. Will we see reductions in auto traffic fatalities? And might those be large enough to actually offset the increases in mortality that we observe from the pandemic itself?

ZOMORODI: Long before the COVID-19 crisis, Anupam was researching human behavior in other scenarios, like whether seniors about to turn 80 or who had just turned 80 got different medical treatment...

JENA: We looked at people who were 79 years old and 50 weeks compared to people who were 80 years old and two weeks. And we looked at how likely they were if they had a heart attack to receive a cardiac bypass surgery, but they only differ by the fact that their age begins with the eight instead of a seven.

ZOMORODI: ...Or whether the youngest kid in class is more likely to get a psychological diagnosis...

JENA: Kids who were born in August are, by definition, in many states, going to be the youngest kid in their class. And if they're the youngest kid in their class, that then raises the question, well, how will they be treated by their peers? How will they be treated by their teachers? One way which they might be treated differently comes to the diagnosis of ADHD.

ZOMORODI: ...Or another example is if marathon day could be bad news for people who aren't even taking part in the race. That was a question that kind of fell into his lap.

JENA: It starts with my wife. She was running a race. And she asked me to watch her on the race route, which happened to go near the hospital where I work, which is called Massachusetts General Hospital. So I was driving down the main thoroughfare in Boston, which is called Storrow Drive, and I was going to get off the road to watch her run by. And as I was approaching that turnoff, I couldn't get off because the road was blocked. And so I came back home, and hours later my wife saw me and she remarked to me, well, you know, what happened to all the people who needed to get to Mass General that day? And that was just an offhand comment by her, but it struck a chord in my mind because, you know, that was a small race. That was a five-mile race. If you imagine a marathon, marathons are incredibly disruptive.

ZOMORODI: Anupam Jena picks up the story from the TEDMED stage.

(SOUNDBITE OF TED TALK)

JENA: We sometimes look important facts right in the face and we miss them completely because we aren't trained to ask the right questions. On the day of the Boston Marathon, police followed standard procedure for marathons in any big city. They closed the roads from the suburbs all the way to downtown Boston to make room for the runners, spectators and the media. Their purpose was to keep the roads free and clear from any auto traffic. That's fine, but what about all the people who urgently needed to get to the hospital that day? What about the ambulances that couldn't get there because the roads are blocked? If you check the data on how many elderly Americans die of cardiac arrest on the days that big cities host marathons, you discover something quite disturbing. Mortality rates tend to run about 15% higher on the days that cities hold marathons compared to the surrounding days. And by implication, when we think about public health, we may miss many important life-or-death facts all around us. I think we miss these facts because seeing is not the same thing as looking. Being a casual observer is not the same thing as being a thoughtful observer and analyzing what you see. And as a result, I think that we're at risk of overlooking important facts in many health care environments because, for the most part, we're not trained to think in larger, creative terms.

I've made a deliberate practice of thinking about health care issues and situations through a big-picture point of view that relies not just on medical data but on the frameworks of economics, sociology, statistics and, yes, even common sense. It's about a new way of looking at the world, a way that could reveal surprising new insights and valuable new truths. The secret I find is to ask creative questions, unusual questions. And sometimes, these questions can come out of left field where the narrow definition of medicine is concerned. But other times, these questions make perfect sense when viewed in the wider context of public health as a whole. And with the right training, each of us can be taught to think differently and find the most interesting of experiments in our everyday lives.

ZOMORODI: Our everyday lives - you just used that phrase. Our everyday lives have been absolutely upended by the coronavirus - how different countries are asking their citizens to behave, in terms of how different health care systems across the world are deciding who to treat and how - all kinds of big, societal experiments going on, it feels like. As someone who has tried to quantify and explain why certain things happen, how do you view the pandemic?

JENA: I'll say a couple of things have occurred to me since the pandemic has started.

ZOMORODI: Yeah.

JENA: So one is whether or not we're going to see delays in care for people who actually need to get to the hospital quickly. I think people who are having chest pain, people who are having shortness of breath, people who are having stroke-like symptoms - those kinds of people may be delaying care and not getting to the hospital as fast as they should. If that's the case, then it tells us that the impact of this pandemic is not just limited to the people who get the disease but to all these other people who are afraid to seek care and experience worse clinical outcomes as a result of those delays in care. We'll be able to study that soon. I think, you know, within the year, we'll know whether or not that happened or not. That is an interesting thing to think about.

ZOMORODI: OK, so here's mine. Mine is, like, we know that the air is actually getting cleaner because there are fewer flights because of this pandemic. Will it sufficiently lower pollution in urban areas to the point where it improves people's respiratory functioning so that actually fewer people die of coronavirus because more people have healthy respiratory systems?

JENA: See, that's a beautiful idea.

ZOMORODI: (Laughter).

JENA: There's two things to that. So one is that, fewer people might have exacerbations of asthma because there's less pollutants in the air, and we know from other studies, high-quality studies, what that relationship looks like. Now, how many fewer people will have asthma exacerbations and deaths when the air quality is better? And then on top of that, could our lungs' response to coronavirus be slightly better because the air quality is also better? And there's some theories about how air quality might affect individuals' predisposition to have complications related to infection. So I think - go ahead. Give me some more ideas.

ZOMORODI: OK, there's more. Yeah.

JENA: That was a good one.

ZOMORODI: OK, so what about divorce rates? We've already seen a spike in divorce rates in China in recent weeks, and you could imagine seeing that happen in countries around the world because couples are cooped up in isolation driving each other bananas.

JENA: I think that's also a great one. The other thing that I've heard is, and there's some data to support this, whether or not we'll observe greater rates of childbirth nine months from now. I'll tell you the closest thing that we've looked at that's related to what you just suggested - it's obviously - it's a difficult thing, but we have looked at whether rates of spousal abuse increased...

ZOMORODI: Oh, gosh.

JENA: ...Because people are...

ZOMORODI: Yes.

JENA: ...Basically stuck in the house. A friend of mine sent me an email which was - his thought was, might there be problems with people who have history of alcoholism because if AA meetings can't happen in person, what's going to be the impact of the absence of those meetings? And there's other such meetings that happen that help people live healthier lives than they otherwise would be able to in the absence of those meetings, so this is something that could be studied. You can - we might see what happens as a result.

ZOMORODI: Yeah. You know, I think everybody says this generation of kids is stuck to their screens. I think that's definitely going to happen, but I also think we're seeing the Internet and Web being used in ways that it was meant to be used in terms of sharing ideas and arts and connection. So I think we're going to see, like, a sea change in the way people use the Web. I don't know how you quantify that one though. So maybe...

JENA: That's quantifiable.

ZOMORODI: Yeah?

JENA: You could look and see. Yeah, you could - because this - the census does surveys and they look at how people allocate their time, whether or not they work from home four days a week - five days a week, so you might see that working at home one day a week increases post-pandemic...

ZOMORODI: Huh.

JENA: ...Compared to before.

ZOMORODI: We started this episode out with talking to science writer Laura Spinney about the lessons learned from the 1918 flu epidemic or pandemic. And, you know, she said the same thing, that you can't - yes, there was a spike in births. Yes, there was a spike in depression. But she was like, you know, but also keep in mind, there were also all sorts of other factors that could have played into things that happened a decade, two decades, even 50 years later. So I guess I'm wondering, you know, as we close the episode with you, what do you imagine potentially the lessons will be 10, 20, 50 years from now. What are - or maybe we don't know what they are, but what are the factors that you're going to be looking at?

JENA: That's like - you might as well have asked me, what's the meaning of life? OK, let me answer...

ZOMORODI: (Laughter).

JENA: ...The meaning of life first and then I'll...

(LAUGHTER)

JENA: You know, I think there's a lot of things that will come out of this. One is, it will be a reckoning of the importance of evidence to guide policy. The central policy from the federal government has not been what many people would have liked, and part of that is it views as being a dearth of reliance on evidence. So perhaps this will put a price on what it means to society if we don't use the best available evidence, and that may change things.

I think the second thing is, which to me is going to be most interesting is that, we have engaged and we have started down a path of intense social distancing, and when we get past this, whenever that is, we will look back and we will think to ourselves, did we underreact, did we overreact, or did we appropriately react? And what worries me is that we'll actually never know the answer to that question because if much fewer people die from this pandemic than people predict, is it because they over-predicted or because we responded effectively and were able to shut the thing down before it could kind of take flight? And I don't know that we'll know the answer to that question, and it's challenging because when this happens again, we're at risk of the same sort of global economic turmoil that has occurred.

(SOUNDBITE OF TED TALK)

JENA: Can we be trained? Can we be taught to ask these larger creative questions as a matter of everyday routine? Absolutely. I think that these skills can be learned and that we would greatly benefit from doing so. And it is in situations like these that I think that natural experiments could illuminate the most about our social behavior. There are amazing insights around us just waiting to be discovered. All we need to do is learn how to look for them. Thank you.

(APPLAUSE)

ZOMORODI: That's Anupam Jena. He's a physician and an economist at Harvard Medical School. You can watch his full talk at tedmed.com.

(SOUNDBITE OF MUSIC)

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