Transcript

Derek Smith:

Hello, and welcome to Baylor Connections, a conversation series with the people shaping our future. Each week, we go in depth with Baylor leaders, professors, and more discussing important topics in higher education, research, and student life. I'm Derek Smith. And our guest today is Dr. Michael Muehlenbein. Dr. Muehlenbein serves as professor and chair in Baylor's department of anthropology. An expert in evolutionary medicine and infectious diseases, public health and public education, Dr. Muehlenbein joined the Baylor faculty in 2017 to lead the university's growing anthropology program. This month, the Board of Regents approved a new PhD program in anthropology, which will specialize in health, a growing focus within the department. A member of Baylor's COVID-19 task force, Dr. Muehlenbein helped to design Baylor's testing protocol and contact tracing, and has led in COVID-19 research throughout the pandemic. This summer, he created a research partnership along with computer science chair and professor Eric Baker with Waco's Family Health Center. The partnership studies the spread of COVID-19 in McLennan County with a survey featuring quantitative and qualitative data on more than 500 participants to better understand who is at risk, study the impact of behaviors or cultural factors, such as poverty and more. It's been a busy stretch for everyone, especially someone in your discipline, Dr. Muehlenbein. And we really appreciate you taking the time to visit us today. Thanks so much for joining us here on Baylor Connections.

Michael Muehlenbein:

Well, thanks for having me Derek. That was a wonderful introduction. I should take you everywhere with me.

Derek Smith:

Oh, good. That's good. Well, you've had a lot going on. Hopefully we summarized it well, and we can unpack that here over the next 20 minutes or so. So, let's start with a broad question. Given your discipline, what's life been like in the pandemic for you and your colleagues, and how have you mobilized to study and lead during a time that really necessitates people like you and your background?

Michael Muehlenbein:

Well, I suppose, I could think about that in terms of my individual response, not just as a professor or a researcher, but also as a father, as someone who's outspoken about my disability with OCD, which makes me really good at some things and really bad at others. And this has been an interesting time to experience it. But also, with not just the community efforts that we've seen, but also the collaborative effort that Baylor has been doing to make sure that we opened up, and stayed open until now. And we're in the home stretch right now and it required effort by hundreds of people, thousands of hours a week. And I'm just a small part of a very big team, and lucky to be part of it.

Derek Smith:

Let me ask you this to kind of set the stage a little more for what we talk about here, I say the word anthropology, you're professor and chair of anthropology, and I think that's something that sometimes can mean different things to different people. So, how should we understand the intersection of your research interests and expertise as it relates to the current moment?

Michael Muehlenbein:

Ah, yes. So, anthropology is technically defined as the study of humans. And although many people may have misconceptions about the discipline, thinking about stones, bones, Indiana Jones, and Jane Goodall it is actually a very broad and deep field. When the mother discipline of zoology began to break into sub-disciplines like psychology, biology, well, anthropology took with it the study of human biology for one. So, that is very clearly an important part that we can use to contribute to understanding, for example, the current pandemic. But it also represents, from an anthropological perspective, the utility of a number of different qualitative and quantitative methods, so that we can understand the human condition at various levels. At the level of the gene, the individual, the population, the global community and so on. So, there are many, many different sub-disciplines within anthropology and a lot of them are helping to inform about the situation we find ourselves in right now. For example, economic anthropologists, psychological anthropologists, biomedical anthropologists. I like to think that the whole world, every individual is in part an anthropologist.

Derek Smith:

Dr. Muehlenbein, you talk about the sub-disciplines within your discipline. And I mentioned at the top of the program, a new PhD program in anthropology specializing in health. We've had at least a couple of your colleagues on the program in the past here. I know we've had Lori Baker on the program, Alan Schultz as well. What's it been like for you all working together during this time? You've got a growing program, which is busy anyway, and then during this sort of bringing all of your expertise together to serve your students and serve the campus and community.

Michael Muehlenbein:

Well, I was recruited and came here specifically to develop the program with a cluster hire, as well as a PhD proposal, both of which focused on health. And it's logical to do that here because within Texas, of course, Baylor is known for health and, specifically, applied health research. So, that is following with Baylor's mission of compassion, of being able to not just conduct empirical and theoretical research on the anthropology of health but specifically using, again, that combination of qualitative and quantitative tools, both lab and field methods, to understand the human experience. And it is unfortunately ironic, I guess, that our expertise in holistically understanding human health is being tested right now in light of this pandemic.

Derek Smith:

Dr. Michael Muehlenbein professor and chair of Baylor's department of anthropology. And Dr. Muehlenbein, you talked about Baylor's efforts to have a safe in-person semester. I know you've been on the COVID-19 task force here at Baylor and played a key role in developing some protocols. So, could you kind of take us inside that a bit and what the last few months have looked like? And how should we, on the outside, understand the various realities and unknowns that you and the team navigated and are navigating?

Michael Muehlenbein:

Yeah, it's a constantly evolving process that, for the majority of us, started in late spring and early summer in preparation for this coming semester, the fall semester. And, now, we're doing it anticipating the spring semester. And that includes meetings about four hours every day with different groups that specialize in either health management decisions, or contact tracing. And looking to other institutions for guidance on how they were conducting surveillance testing, onboard testing, so prior to arrival to campus. But then, all the little details, like how is the messaging going to come across to parents and students? How do we safely feed individuals? What kind of environmental engineering is needed in the buildings? What kind of sanitation protocols are needed in the classrooms? We're talking about hundreds of individuals and thousands of hours daily devoted to understanding and monitoring the situation from day to day. Being able to implement, for example, the surge testing in response to Deborah Burke's visit that, in turn, allowed us to pivot our testing to locations on and off campus that, when we saw an increase in cases, we were able to respond quickly because of the integrative nature of this complex team. And it's not just the testing, or the contact tracing. But it is, importantly, thinking about the student experience, trying to keep some type of normality for everyone involved. And that means thinking about where their meal's coming from, how much isolation capacity do we have for students who are tested positive, and tracking these individuals, and their satisfaction even. So, it is a extremely complex process that is continuing to happen. And now, of course, we are planning for the spring semester, which is likely to bring a new set of challenges with an anticipated increase in the number of cases throughout the holidays.

Derek Smith:

Dr. Muehlenbein, you did a great job there kind of describing some of those logistical questions. And I'm curious, as we think through what you and your colleagues from various disciplines coming together brought to bear, are there philosophical questions as you think about, okay, if we do X, we also need to think about Y? Or are there philosophical questions that you all kind of navigated in putting this together?

Michael Muehlenbein:

Well, personally, when I think about this, I think about doing things in terms of just because we should do it doesn't mean we should. And there are a number of ethical issues that the pandemic has highlighted. For example, the idea of behaving individualistically as opposed to the common good, or a communal orientation. Because when we think about wearing masks and social distancing, people need to realize that they're not just doing it for themselves, but they're doing it for others. And you can think of the same way in terms of vaccination, because even with a vaccine that is 95% defective, we still need a significant proportion of the population willing to get vaccinated. So, these to me are ethical questions that I think about daily, especially at a disconcerting time, when an estimated 50% of the population is reporting that they're unwilling to mask any further, or social distance, or receive a vaccine.

Derek Smith:

Do you find Dr. Muehlenbein even all these months in, and I think you just alluded to this, but that there's still some either confusion, or even, obviously, maybe some sense of not wanting to participate in some of these things that are helpful, particularly as it relates to as people go home, perhaps they come into contact with someone, who has COVID-19, and they understandably want to see their family, and maybe they test negative personally. Don't understand why they're being asked to quarantine for 10 to 14 more days. Do you kind of find some still lack of understanding about why all those things are important?

Michael Muehlenbein:

Yes. And this is problematic. A little soap box of mine that I tend to get on when I talk about COVID is the fact that our national and international leaders have largely failed in accurate communication about the pandemic. And some would say, we find ourselves in an info-demic. So, we have too much information, we don't know which source to trust. And that leads a lot of people to believe in things like conspiracy theories. Or to not trust scientists. And, of course, these are not new phenomenon. They've been happening for centuries. But one of the main problems is that a lot of the science that we know about COVID is not recent. It's not like it happened last month that we realized that aerosol transmission is possible. We didn't just realize now that asymptomatic transmission was significant. These are things that we've known for many, many months, arguably at the beginning of the outbreak. And there's been inconsistent communication about things like the roles of asymptomatic individuals and transmission, the utility of masks, including neck gaiters and face shields. The role of children in transmission, the idea that this is just a flu, and then it will infect only the elderly and infirm. When we knew early on that, none of this was true. These were inappropriate assumptions that led to confusing communication that even organizations, like the CDC and WHO, had to put out and then backtrack on. Now, we know that, for example, asymptomatic transmission is responsible for more than half of the cases of the SARS-CoV-2 virus trend. So, the CDC is just now recognizing this in print on the website, but it's also something that we knew earlier on in the spring semester. So, these kind of confusions lead people to distrust science, combined with COVID fatigue you will see a decrease in compliance to public health measures. Now, the science is out there and there are ways of finding it, which is one of the projects that I've been working on in collecting now thousands of research articles, and press releases, and organizing them by subtopics, so that the Baylor can choose for themselves instead of finding their information filtered through social media, which is highly problematic here, they can go straight to the source. We are academics by nature that the community we find ourselves in of scholarly learning, then you would think that these individuals would want to go to the primary sources, and read, and see, and interpret for themselves the science. And that's kind of difficult to do without being led to the resources themselves.

Derek Smith:

You mentioned you compiled, working with your students, thousands of articles on the subject. Are there any themes? When you think of most of us, as laymen out here, are there any themes from those that have stood out to you, and your students that are just very some practical things for people to wrap their arms around?

Michael Muehlenbein:

Yeah so, this started out of, again, a placement for my OCD tendencies in the spring semester, anticipating the need to teach a class on COVID, which I'm going to offer next semester. And I was just spending about an hour to two hours every day, pulling the primary literature and organizing it into topics from as fine-grained as genomic diversification and bat origins to the economic and social impacts to the differential effects on minority populations and prisoners. But things that, obviously, have made the news most frequently could arguably be the utility of masks, and different types of masks, the utility of testing. If I just test it today, why do I need to test tomorrow kind of thing. And that's because some early tests were not as accurate as they could have been. But we know that frequency of testing is really, really important just because you tested negative right now doesn't mean it's a good idea for you to hug grandma tomorrow. There are a number of that ... I mean, there are tests out there, very accurate tests, but you may be too early in infection in order for that test to determine your true positive nature. So, it is still possible to transmit, even following a recent negative test. The billion dollar question that people are talking about, besides of course the vaccines and availability, the billion dollar question is whether or not someone who gets the SARS-CoV-2, if they are protected against reinfection? And if they are, how long are they protected? And we don't know the answers to that yet. Every day the science points to it looking a little bit better than we knew the day before. For example, early studies suggest that antibody levels decreased relatively rapidly after infection. But we, now, know that levels of neutralizing antibodies and T-cell activity are probably sufficient out to six months. But, again, we have not conclusively been able to determine whether or not you getting COVID protects you from getting it again. In fact, there are now dozens of examples of reinfection, although it's likely that they were reinfected, these people were reinfected with a different strain of the virus. And, again, the other main theme that seems to come out is what is the utility of continued masking, and social distancing? And then, of course, there is a large portion of the media still focusing on things like whether or not the virus exists. And that's a little disappointing because we are seeing an exponential increase in the number of cases now.

Derek Smith:

Visiting with Dr. Muehlenbein, bio and professor and chair in Baylor's department of anthropology. And Dr. Muehlenbein, I want to shift gears a little bit and talk about a community minded project that you and other colleagues across campus have provided leadership on in partnership with the Family Health Center, the COVID-19 survey. And mentioned that briefly at the top of the program, but could you take us a little more in-depth, and give us an overview of that project, and what it's designed to do, the information it is designed to glean to help people?

Michael Muehlenbein:

Sure. Well, it was in mid spring that myself and others, including Dr. Eric Baker, professor and chair of computer science, were recruited to participate in the mayor's COVID task force for McLennan County. And during that process, Eric and I began talking about our capabilities of monitoring the COVID-19 situation, specifically, in our community. We knew what was happening in Asia and Europe at the time. This is before mass spread in the US. Although, I will say that there's evidence now of early cases in California in last December. But before that, before mass spread we were just out of ... or rather just starting the initial lockdown from March 13th, and knew that our government, at some point, our businesses were going to reopen because this is a delicate balance between human lives and local economies, obviously. And so, we began speculating about what would happen in our community when businesses started to open back up, when restaurants would increase capacity, would we see changes in transmission and specifically asymptomatic transmission? Because if you look at other respiratory tract infections, just say, respiratory syncytial virus, or influenza that these are viruses that are spread asymptomatically by any age group, including by aerosols, not just large droplets, or contact. But what would this look like at the community level? And that's because there's been a lot of conversation about something referred to as the R0, or the Rt, the effective reproduction number of the virus. And that number, typically, represents the number of people who are susceptible that would get infected by a single infectious person. Pathogens that spread very quickly have very high R0, or Rt values like measles, for example. And so, we were speculating about what it would look like here for the SARS-CoV-2 virus. And, importantly, that is a number that is specific to a population at one point in time, depending on largely human behaviors as well as, of course, some biological properties of the virus itself. But human behaviors, even in different subgroups. So, theoretically you could calculate an R0 value for Baylor, for Baylor students on campus, Baylor students off campus, for minority populations in the county, for the county itself. But we were considering the number somewhere around two, which is what we've seen in other locations, but we know that it changes throughout time. And so, we wanted to be able to better inform local leadership here in McLennan County about what they should consider doing when businesses do start to open back up. And then, specifically, look at behaviors and attitudes that can help us to predict the likelihood of infection. And so, that led us to drafting up a proposal for a project that was to include about 500 individuals throughout McLennan County 18 years of age or older, who would register on our website. And then, be invited to participate in an extensive survey about 140 questions that covered things from demographics and health history to knowledge, attitudes, and practices when it comes to virus prevention, hygiene, religiosity, political leniency, and all sorts of other factors that could play a role in influencing someone's willingness to take risks when it comes to this pandemic. And these individuals would complete the survey, they'd come into the Family Health Center for a blood sample, and we would be able to determine well, besides some basic cellular measures of health, their IgG levels, which is an antibody against the SARS-CoV-2. So, this would theoretically tell us whether or not someone was likely to have been infected within the past several months but, importantly, were asymptomatic this entire time. Because, again, early on we didn't know exactly what proportion of asymptomatic individuals would be contributing to infection, but we knew it would be significant. So, to date, we've recruited about 500 individuals who have completed the survey, donate a blood sample, but then have done that two to three more times once a month, so that we can track their likelihood of getting infected. And that's really the power in the data set here is to looking at how individuals' behaviors and attitudes have influenced their likelihood of eventually contracting the virus.

Derek Smith:

And Dr. Muehlenbein, when you look at those questions, you have the quantitative data about health and transmission then, you have the qualitative data that you find in the questions. How do you tie that qualitative data together, and then compare it to the quantitative in ways that are helpful? That seems like a lot of information to wrap your arms around. So, what are some of the ways you do that?

Michael Muehlenbein:

Well, the biggest benefit, I think, of the dataset is that with the quantitative data we're looking at the likelihood of testing positive over the course of three months. And qualitatively, we can specifically look at what influences someone's willingness to take risks. Is this because of a particular line of employment? Because we do break these individuals down into different risks groups. You've got your healthcare providers, your frontline workers, those that are arguably at the highest risk. But still, again, remember all of them being asymptomatic. And then, you have what were deemed essential employees. You have those that considered, well, at least reported to have compliant to all lockdown requirements, and really haven't left their house much except for H-E-B curbside delivery, things like that. So, importantly, we can look at the different risk factors, at least as they report them. But then, we can also look at other things like, for example, we know that minority groups are disproportionately affected by the virus. That a higher likelihood of not only getting the virus, but also being hospitalized and dying. And there are a number of explanations for that, including access to healthcare among others. But we're looking at household size. We can look geographically, knowing where these individuals live to identify even neighborhoods that have a higher likelihood of getting infected.

Derek Smith:

Visiting with Dr. Michael Muehlenbein. And Dr. Muehlenbein, as we head in the final couple of minutes of the program wanted to ask you, as we look forward on this survey what are some of the ways that the information is actively being used in some practical ways? And what do you see ahead for this information maybe even beyond the current COVID moment?

Michael Muehlenbein:

Well, importantly, there has been an enormous amount of research on COVID. If you look at PubMed, the National Institute for Health, their library system, there are more than 50,000 unique hits for COVID-19 right now. If you look at Google Scholar there's somewhere around 1.3 million. And so, that means that a lot of the things that the survey was originally designed to determine have already been identified in other populations. Like the relative contribution of asymptomatic individuals in transmission. This will allow us to specifically apply those principles to McLennan County because not all cities are the same, not all countries are the same. We've seen this, obviously, if you look at the spread of the virus in Italy versus Taiwan. And so, we're importantly taking a regional approach, especially when it comes to also the presence of Baylor University here. We talk frequently about the Baylor bubble. But the reality is that Baylor University is integrated into the community locally. And about 60,000 of our 250,000 individuals in the McLennan County live below the poverty line. And so testing, for example, the intensive surveillance testing that we've been doing at Baylor, and we hope to increase in the spring semester, we're doing it not just to decrease the number of cases, identify them early, and have them isolate, or identify the contacts and have them quarantine. But we're doing that to protect the people that we live around, not just the Baylor community.

Derek Smith:

Great. Well, Dr. Muehlenbein, I really appreciate you sharing these thoughts. And as we wind down here, I'll ask you, I think you've referenced this, in fact, I know you have, but I want to ask you specifically, as we close. For people as they head home, as students at home for break, as people get time off of work what are a couple of things they should think about as they think about their own role in protecting their community, both immediate and more broadly, as we head into the winter months?

Michael Muehlenbein:

I think the most important thing to remember is don't give up yet. I know it's hard. It's hard on everybody. It's harder on some than others, that we should acknowledge. Just because you don't know someone who suffered from COVID, or died from COVID doesn't mean it's not real. It doesn't mean you can't play a very important role by abiding to public health recommendations. And, importantly, social distancing, hygiene, and masking are not oppressive. Inconvenience is not equivalent to oppression. And we should, at this time, be giving thanks, not be giving COVID to other people.

Derek Smith:

Well, Dr. Muehlenbein, I really appreciate your time today. Thanks so much for joining us. Thank you so much.

Michael Muehlenbein:

Thanks Derek.

Derek Smith:

Thank you. Dr. Michael Muehlenbein, professor and chair in Baylor's department of anthropology, our guest today here on Baylor Connections. I'm Derek Smith. A reminder, you can hear this and other programs online at baylor.edu/connections, and you can subscribe to the podcast on iTunes. Thanks for joining us here on Baylor Connections.