Paul Farmer, lecturing during a Nov. 3 class
This article is part of Harvard Medical School’s continuing coverage of medicine, biomedical research, medical education and policy related to the SARS-CoV-2 pandemic and the disease COVID-19.
It's not an opportunity that comes along every year — the chance to analyze a momentous period of history as you're living it. But that's the core purpose of an innovative class that's utilizing the expertise of top Harvard physicians, scientists and researchers this fall to better understand and learn from the COVID-19 pandemic.
“I think we [in the U.S.] have, for a very long time, taken public health, as a institution, for granted, because we are an industrialized nation, we have a lot of wealth, a lot of resources,” said David A. Walton, a recent guest lecturer in the course, called Confronting COVID-19: Science, History, Policy.
A Harvard Medical School instructor in medicine at Brigham and Women’s Hospital, Walton is co-founder of Build Health International. He has responded to several global health crises, such as the 2010 cholera outbreak in Haiti and the 2014 Ebola epidemic in Sierra Leone.
Joining him for this particular class were two additional guest lecturers: Paul Farmer, the Kolokotrones University Professor of Global Health and Social Medicine and head of the HMS Department of Global Health and Social Medicine, and Jessica Cohen, the Bruce A. Beal, Robert L. Beal, and Alexander S. Beal Associate Professor of Global Health at the Harvard T.H. Chan School of Public Health.
All three reviewed aspects of international responses to global health threats such as malaria, tuberculosis, Ebola and COVID-19 to outline what they see as the major factors contributing to the spread of catastrophic diseases and the most effective responses.
For Farmer, a significant element contributing to the COVID-19 pandemic is what he called “containment nihilism,” or a policy adopted by some governments that assumes once a disease has spread to a certain extent then “it’s too late to stop the epidemic.”
“That’s probably where we are right now as a nation,” Farmer said.
It was a powerful and sobering comment, but for students enrolled in the class the discussions also offer a way to make sense of the history they are living daily.
Aaron Shirley, a Virginia native and a sophomore at Harvard, is taking the class remotely from Washington, D.C.
“I don’t think anywhere else there is a course offered like this, or at any point in time would I be able to take a class that’s so relevant, happening right now,” said Shirley in a telephone interview. “We’re getting all these different perspectives from leading scholars in their fields. I mean, who can say they studied what was happening, while it was happening … in college?”
Across the river
The distance from the Harvard University campus in Cambridge to the HMS Quadrangle in Boston is between 2.5 and 4 miles, depending on the route taken.
But Boston traffic can make getting across the Charles River seem like a heavy lift, and has, in the past, created barriers to interdisciplinary “cross-river” courses featuring faculty from both campuses, according to Allan Brandt, Harvard professor of the history of science and the Amalie Moses Kass Professor of the History of Medicine.
“I would talk to my medical school colleagues, for example, and they would say, ‘I’d love to come over and teach in your undergraduate course,’” said Brandt, “but then when you begin to invite people they would say, ‘You know, that’s a really hard time for me,’ or ‘It’s really hard to park in Harvard Square,’ or ‘You know, I can’t really be away for the whole morning,’ and it was always difficult.”
But the coronavirus pandemic has changed any number of things. The need to move to remote learning for classes this fall has helped facilitate involvement of Harvard faculty from both sides of the river in the course, which is led by Brandt and Ingrid Katz, an HMS assistant professor of medicine at Brigham and Women’s and an infectious disease expert who is also associate faculty director at the Harvard Global Health Institute.
Through the ease of teleconferencing, this interdisciplinary group of Harvard faculty is providing Harvard students located around the world with a rare window into medical clinics and hospitals, and an opportunity to analyze scientific, social, and political elements of the U.S. and global responses to the crisis.
“One of the things that Ingrid and I wanted to do was to also show undergraduates how deeply engaged the Harvard faculty has become in the COVID pandemic,” said Brandt. “So many faculty shifted, in sometimes radical ways, to try and understand COVID, working on treatments and vaccines. What’s the best way to treat patients? What’s the best way to secure hospitals from the infections? So, we really wanted to demonstrate to our class that … Harvard faculty are really fundamentally engaged in virtually every aspect of the pandemic.”
The course features more than 20 different sessions and meets for 90 minutes twice a week. The semester began with discussions on topics such as what is an epidemic/pandemic and has included sessions on epidemiology, diagnostics and testing, clinical and hospital responses, treatments, the hunt for a vaccine, racism and disease, masks, the political and economic impacts, gender issues and mental health.
One of the first sessions dealt with how Harvard responded to the pandemic and how the University formulated policies for reopening the campus, with Alan Garber, University provost and the Mallinckrodt Professor of Health Care Policy at HMS, and Giang Nyugen, director of Harvard University Health Services, serving as guest lecturers.
A class on epidemiology featured Maimuna Majumder, a research associate in Health Care Policy at HMS and a faculty member of the Computational Health Informatics Program at Boston Children’s Hospital, and lecturers Caroline Buckee and William Hanage, each an associate professor of epidemiology at the Harvard Chan School.
A class covering clinical and hospital responses to the pandemic included Katrina Armstrong, the Jackson Professor of Clinical Medicine at HMS and chair of the Department of Medicine at Massachusetts General Hospital, along with Paul Biddinger, vice chairman for emergency preparedness in the Department of Emergency Medicine at Mass General.
“One of the really unique aspects of what we’re seeing right now is the cross-disciplinary nature of this work,” said Katz. “Whether you’re a historian or you’re an epidemiologist, or you’re a physician on the frontlines, you’re engaged in COVID in this moment, in some way. That’s what’s been very profound for me as a physician, to see all of these other disciplines coming together … all of these people made this decision to add COVID to the work they’re doing or make it exclusively what they’re doing.”
‘This colossal crisis’
Brandt said 130 students are enrolled in the class and the course is giving many of them a way to “develop skills and methods and approaches to understanding this colossal crisis that we’re facing.”
Shirley said that as a Black premed student he particularly appreciates the course’s cross-disciplinary approach, one that touches on more than just the biology or virology of COVID-19.
“I was so inspired and happy to see that we were reading these articles about racism in health care and that this class was bringing attention to it,” he said, adding that the course has examined a broader spectrum of systemic racism than he has encountered before, one that affects many different ethnicities and communities of color.
“I’m excited to learn about it and apply it and, hopefully, if I do go to medical school, I will apply it and be a better physician for it,” Shirley said.
Although some students in the course are premed, Brandt said, there are other students approaching the content from legal or even literary perspectives.
Judy Durkin, a Harvard junior taking the class remotely from Vienna, Austria, said in a videoconference interview that her academic concentration is the history of science, with a secondary concentration in global health.
She said what she appreciates about the course is “the fact that we’re able to speak to leading experts, the same people we’re reading about in the news every day.”
“The course is super engaging, very unique, totally unlike any other course I’ve taken at Harvard, and the projects and assignments are really exciting,” Durkin said. “I have to admit I’ve never totally understood how a virus works until now and I think that’s such a testament to the speakers.”
She said that, for her, one of the most insightful lectures so far involved the discussion about the thinking that went into transitioning Harvard to remote work at the start of the pandemic, primarily because the speakers were so candid and because it was an opportunity to “piece together the history that I was directly a part of during the pandemic.”
“I think when you’re able to analyze that in real time, something really changes, and I think I have a much deeper appreciation for the work that historians do,” she said.
As a final project, students will produce podcasts interviewing a variety of people about their experience of the pandemic. These recordings will be included in Harvard’s archives, she said.
Durkin grew up in the Los Angeles area, and her podcast will focus on how the pandemic has affected actors and the theater industry.
“The pandemic has obviously kind of wrecked the performing arts industry on so many levels, and I wanted to preserve exactly what has happened to actors during the pandemic, especially at the beginning, because health care was a really hard thing for people to get … a lot of actors had no health insurance, no work,” she said. “I want to allow actors to talk about that experience, so that it’s not glossed over later.”
Both Brandt and Katz have done research in HIV, and it’s important to both of them that the students grasp not only the medical but also the social and economic impacts of the pandemic.
“I think pandemics have a way of shining a spotlight on the inherent inequalities that are there already. And this is that moment,” said Katz.
“So many people who are at the frontlines of clinical care and research in COVID really began in HIV. We have a clinician scientist [lecturer] from MGH … and he’s really an expert HIV clinician, but he’s going to talk about some of the similarities and differences of treating HIV patients and COVID patients and differences in the diseases,” she said.
Brandt said it’s important that Harvard students have the opportunity to see issues wrought by the crisis outside of traditional, highly specialized siloes, so they can get a wide range of perspectives.
“No single discipline can explain or account for a global problem like COVID, and we want them to understand COVID deeply, but I think we also want them to understand the nature of the way disciplines relate to one another,” said Brandt. “The obstacles to interdisciplinarity, genuine interdisciplinarity, are gigantic. So every time we can chip away at some of those obstacles, I think then we're doing something potentially of value.”
