Michigan expert on history’s pandemics reflects on end of COVID emergency

• An expert in epidemics, Dr. Howard Markel shared his thoughts on the U.S. handling of the COVID-19 pandemic
• The public health emergency ends Thursday, but it’s not really over for millions, he said
• What we’ve truly learned from the pandemic remains to be seen. There’s some optimism, but he’s not gushing with it

Dr. Howard Markel, a distinguished professor of medical history at the University of Michigan, has studied the world’s deadliest waves of disease — “rather wacky” but useful work, he said, as he has been often called upon during the COVID-19 pandemic to draw lessons from past horrors. 

In the 1980s, Markel worked with AIDS patients. It was a grim, seemingly hopeless effort at the outset of that pandemic, when there were no drugs to help them. 

While COVID raged off and on for these past three years, Markel isolated himself in libraries and among historic documents, including those while on sabbatical at Cambridge University in England to research his latest book, about the life of Charles Darwin.

Last week, Markel sat down with Bridge Michigan at an Ann Arbor coffee shop to talk about the official end of the federal government’s public health emergency. 

Related:

• COVID public health emergency ends Thursday, what it means for Michigan
• FDA authorizes another COVID booster for older people. What you need to know
• On second look, Michigan’s COVID death rate wasn’t so bad, study finds

Over a cup of tea and milk, a stack of his books and the New York Times  at his side, Markel revealed that his own battle with COVID continues to linger. At one point he apologized as his thoughts scattered — a remnant, he said, of a COVID infection he contracted in January.

Here are a few of his thoughts in the hour-long interview. They have been edited for clarity and brevity.

Q: The official end of the COVID public health emergency is Thursday,  May 11. So, is it really over?

We’re likely to call this a pandemic that doesn’t peter out…In this era, where the virus changes so much, and it seems to always zig when we say zag, I will say I'm not confident (it’s over.)

The White House is talking about the winding down process (of the public health emergency.) I’d like to go back to life. We all want to go back. I understand why you want to — socially, economically, stock market-wise. I get that. But more than 200,000 people died in America alone last year. That's a lot. People are still getting sick.

And there’s post traumatic stress syndrome. I think to some extent, we're gonna find out PTSD is much more widespread and over a much wider spectrum than we think. It’s a tragedy. How many people lost loved ones? And how do near-death experiences affect people, like being put on a ventilator?

And there is long COVID (which doctors are still struggling to understand.) The problem with a new syndrome is that you don't have (a formula) like ‘Agent Y equals disease Z.’ Instead, there are these issues without clear blood tests, without clear anatomical markers.

No, we’re not done with COVID by a long shot. 

Q: COVID literally reshaped some of the world — like real estate.

The office space is markedly different…Restaurants closed, movie houses.  Clothing stores went belly up. Now what do you do with that real estate when most people can do extraordinary things like ( grocery shop) with insta(cart or) whatever? 

I do almost everything from home. Cocooning has become a high art.

The way technology buttressed the awfulness of certain people in a certain job. I can work at home, but baristas? Those people were in harm's way all the time from before the vaccine.

“We’re likely to need (COVID boosters) every six months, and (they need to be free) for underprivileged people who have so many barriers anyway. 

(Few media outlets) covered as much as they should have about the poor people in Detroit who were getting mowed over by COVID, because they were poor people with other conditions and they never saw a doctor and they lived in a neighborhood with no houses.

(Those disparities) remain an issue.

Q: You worked with AIDS patients, have written and talked about pandemics extensively, and you help lead the digital encyclopedia of the 1918 flu pandemic. How does COVID compare?

When I was treating these patients with AIDS, they would die like flies. But now (with the availability of lifesaving drugs) you could live longer with AIDS; it’s almost like diabetes, Type II.

That's the hope with COVID.

People who are alive today that never would have been years ago —  transplant patients, elderly, cancer patients,  AIDS patients, you name it —  are at risk for the worst COVID infection. It's not just 10 of them. There's many millions of them…. People are still living in quarantine.

It’s not over.

Q: While researching some of your previous work, you helped coin the term “flattening the curve;” meaning to keep as many people as healthy as possible so a pandemic doesn’t overwhelm our systems. But you feel like we heed many of those lessons from the past?

The idea was something was likely to happen, and (we discussed in 2005 and 2006): What would we do, for example, for people who have to show up for work, (who) literally have to be present?

But the whole thing had to be reinvented again at crisis time in 2020. This kind of uncertainty, this kind of just-in-time bullshit planning by the seat of our pants is something we can no longer afford. I’m not so sure we’ve learned that now.

I’m not sure we did, but I hope so.

There has always been politicization in epidemic crises. There have  always been counter explanations… But with the internet and social media, sowing the seeds of discontent has never been more accessible and the volume has never been louder.

I worry about anti-vaccine (sentiment.) It goes all the way back to Edward Jenner (and the smallpox vaccine Jenner created in 1796). So that’s not new, but it’s so much bigger because so many more people are collecting through the internet. I think a lot of scientists and doctors have far too long discounted those naysayers. Now we've discovered … the power of the collection of these naysayers.

This is the (pandemic) I'll be studying for the rest of my life, because it's the first really post-modern, post-social-media, post-leaders who don’t respect guardrails, and those processes don't tend to get smaller, they get bigger.

Q: And you were sick, too — just recently, after returning from your sabbatical in Cambridge where you’re researching your new book?

Even at Cambridge, I didn't go to crowded halls. I wore a mask if I went to a lecture. I didn’t hang out in town on the weekends when there were a bunch of tourists. 

But then I went through this human petri dish at either Heathrow or (Detroit) Metro (airports). Probably somebody coughed on me, or whatever. I was sick as a dog. I was extremely exhausted — that was the big one — but also fever and GI symptoms. I'm much better today. 

But it’s like, if I still hear a bell … I’ll lose my train of thought. Or I’m writing, and I’ll forget a word. I make my living out of that. Our facility with words as writers is a superpower. It's really disturbing. 

Q: And even as an expert, you were wrong in your predictions at some points?

Most coronaviruses do go away with warm weather and I hoped in early January (2020) that it would resolve by June, which is what the SARS coronavirus does and what most coronaviruses do. I was wrong about that.

And I thought the vaccine would take longer, but the basic science that was there sped up the process.

Q: Where do you find hope?

What we are finding is less scapegoating. The epidemics I studied in the early 20th century were often tied -- or thought to be tied -- to Jewish immigrants, for example.

The pandemic that formerly took a lot of the popular imagination was the flu pandemic. And what happened almost immediately after 1918 and 1919? The roaring 20s. They’re what F. Scott Fitzgerald called “the greatest, gaudiest spree” in American history. 

Look at what happened then. There was great literature. Theater blossomed. There were great popular songs. 

I don’t know if they’re connected. I don’t know if that will happen. Maybe we’ll be a bunch of isolated, depressed people. I leave that to the future. But this is why this is the pandemic I want to continue studying.