VUMC infectious disease expert Dr. William Schaffner



Tennessee has taken one of the most aggressive approaches to reopen its economy in the country, having reopened most nonessential businesses last week with personal care business, such as salons and barbershops, set to reopen this week.

At the cusp of reopening, the Nashville Post spoke with Dr. William Schaffner, Vanderbilt University Medical Center professor of preventive medicine and infectious diseases, on whether the state was ready to take such bold steps forward without data from expanded testing initiatives.

A week into the reopening process, Schaffner reflects on the concepts of balancing the economy's health with the pandemic and what lies ahead for COVID-19 and Tennessee residents. 

How are you feeling about the reopening as it occurs?

I’m cautious, perhaps I might say I’m cautiously optimistic but also cautiously concerned. Clearly, as we slowly open up, and as people in other states slowly open up, there is a concern among all of us that folks may become more lax in social distancing. They won’t wear their mask, they won’t be as careful about staying six feet away, they will clearly go out more, encountering other persons, they may be more casual about their hand hygiene. If all of that does take place this virus is just waiting, because it’s so contagious, to move from one person to another, to continue to cause illness, and we would see an uptick in number of new infections.

So, we are all a bit wary in going forward, recognizing that we must go forward. There are economic, cultural and social imperatives that really say we can’t keep hunkering down forever. So the question isn’t whenever, but how, we go forward, and you have to keep the medical issues in balance with the economic, cultural and social issues. The medical people are the most concerned, and the people who are in economic distress, and that is very real — as real as the COVID illnesses — those people would like to go a little faster because they have mortgages to pay and rent and electric bills and such.

If we all continue to realize we are in this together, we are trying to help each other, and we try to do it cautiously, let’s just see what happens. We can manage this.

Do you think reopening and stopping the spread is sustainable even with social distancing guidelines? 

Well, I’m not sure but I am of the general opinion that this is such a contagious virus that by opening up, we will increase the number of new infections. I think that is pretty straightforward unless this virus is quite seasonal. You know, influenza has pretty much disappeared already. Influenza is strikingly seasonal, but we don’t know whether this virus has a seasonal component.

There’s been a lot of talk about that as things get warmer, is it more difficult for this virus to be transmitted from one person to another. The answer is maybe. But we aren’t outside all the time. We are indoors where there is air conditioning and it's not so hot and humid. So, there are indoor opportunities for transmission to occur. I think it's inevitable that we will get some increases in transmission, the question is can we keep the curve flattened down while we are doing this.

Is the possibility of a larger spike this winter if the virus is seasonal cause to reopen the economy now during the summer?

I think it is almost certain we will have an increase in this virus again, along with influenza, next fall. The CDC director has warned us about this and I think virtually all infectious disease doctors and public health doctors predict that will happen. We are trying to get ready for that. Now, it’s another question whether we will ever go back to as complete a shutdown as we already have done. I’m not sure that there are many political leaders at the local, state or national level who would do that.

I think we need to do everything we can to recognize we are moving into a new normal. I do hear people say occasionally ‘I wish things would go back to the way it was.’ We can’t do that. We have to be attentive to our hand hygiene. We have to be a little bit more aware about those six-foot distances. And masks, I think, may become a regular winter fashion statement as they are in Eastern countries and have been for years and years. It should not be strange. 

Do you think the pace at which Tennessee reopening is too fast? 

No state that is opening up has met the guidelines established nationally. Those states that are moving ahead are going ahead of what the recommended guidelines are. Those are decisions that are being made, so it’s no longer whether we are going to do this, but when, and more importantly, how?

If we do this cautiously and we do it with the acknowledgment that we cannot just toss our masks and bandanas aside and go back doing it the way we used to, then I think we can manage this. I’m not sure we have that communal determination to be careful and to be careful not only for ourselves but for others. 

Some governors, in their own wisdom and judgment, are going faster than others, and we are kind of in that lead group. Our cases are not as severe as in other parts of the country. I’m not defending what the governor is doing. I’m a medical professional, a public health person. I’d like us to go a little more slowly, but you know, I have money to pay my electric bill next month. I have a job that keeps me compensated. There are people in dire financial stress getting worse almost day by day.

There is this balance that has to take place. We are all in this together and I’m a person who wants us all to work together to do the best we can to get through this. Because whichever things we do, we cannot keep hunkering down for a long period of time. There is going to be economic, social and cultural damage. If we go too fast, there’s going to be medical damage. What we are trying to do is walk the tightrope. 

This post originally appeared in our sister publication, the Nashville Post

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