Soledad O'Brien moderates a panel of preeminent public health experts who discuss lessons learned from the coronavirus pandemic and what we need to know as we prepare for another surge. The panel comprises: Dr. Oxiris Barbot, former New York City commissioner of health); Dr. Abdul El-Sayed, a physician and epidemiologist and the author of the book Healing Politics; and Brian C. Castrucci, an epidemiologist and the president and chief executive officer of the de Beaumont Foundation, a charitable foundation focusing on public health.
SOLEDAD O'BRIEN: Hi, everybody, and welcome. I'm Soledad O'Brien. And I am your host for our conversation today. I've been a journalist for a long time, and I am also the producer of the documentary, "Outbreak, The First Response." It's sponsored by the de Beaumont Foundation, which aims to create and invest in bold solutions that improve the health of communities across the country.
They are also the sponsors of our discussion today on Yahoo Life, Coronavirus, The Second Wave. So I'm going to begin by introducing my panelists to you. Our panelists are Dr. Oxiris Barbot, a pediatrician who served as the commissioner of health of the city of New York during the height of the pandemic. It's so nice to see you.
OXIRIS BARBOT: Good to see you.
SOLEDAD O'BRIEN: Thank you. Dr. Abdul El-Sayed, a physician epidemiologist, public health expert, progressive activist. He's also the author of "Healing Politics," which diagnoses the country's epidemic of insecurity and the empathy politics are going to need to treat it. It's nice to see you.
ABDUL EL-SAYED: Thank you.
SOLEDAD O'BRIEN: Dr. Brian Castrucci is the president and chief executive officer of the de Beaumont Foundation. He's also an award-winning epidemiologist with 10 years of experience working in state and local health departments. It's nice to see you, Brian.
BRIAN CASTRUCCI: Thanks, Soledad.
SOLEDAD O'BRIEN: Hi there. All right, let's get right into it. We know that public health officials, in many ways, are the canaries in the coal mine and certainly were at the beginning of this pandemic. As the cases rose sharply, it was public health officials that were doing the warning of shutting things down.
But for the most part, I think many leaders listened a little bit too late. And now we're looking at a death toll of about 210,000. So what comes next? We turn back to public health leaders to discuss the lessons that we learned from this pandemic so far and what could be coming down the pike.
So Oxiris, if I may start with you, we know that around March 1st, we began to know that there were cases in the city of New York, where you were working. What was the red flag for you? When did you think, hey, we need to be thinking about shutting down? And when was the city actually shut down in a way that you thought was appropriate?
OXIRIS BARBOT: So Soledad, we did have our first confirmed case on March 1st. And shortly thereafter, we were able to document that we had what we called community transmission, which meant that these weren't cases that were coming in from China or anywhere else directly, but that they were being exposed and infected from other people in New York City.
And so with the sophisticated technology that we have where we get input from all of the emergency departments in the city, we saw that between the 2nd of March and the 6th of March, we were seeing an increase in the number of people that were coming into the emergency department with symptoms potentially consistent with COVID-19. And so we began the conversations in earnest at that time. We ended up as a city shutting down our schools on the 16th of March. And then shortly thereafter the governor and the mayor together put in place the New York state pause.
SOLEDAD O'BRIEN: So when you look at that date, I know the first death in New York-- in Brooklyn, I believe-- was the 15th. By the 16th, schools were shut down. As you well know, there were people who said that 16-day window was too long. Do you think it was too slow to really shut down the city?
OXIRIS BARBOT: You know, absolutely. I think we were slow on making that decision. And part of what I hope we've learned from phase one is that COVID is like a supersonic train. Once it gains momentum, you can't dither with the decision making. You need to act fast to put into place measures that are going to keep it from continuing to transmit.
SOLEDAD O'BRIEN: Abdul, tell me a little bit about what we know about how much of the population now has had coronavirus. What do we know about the virus? What have we learned?
ABDUL EL-SAYED: Well, Soledad, let me just step back for a second. There are two things I want folks to appreciate and understand about a virus like this. Just like Oxiris shared, once you become aware, it's already too late, because we're talking about exponential math, not linear math. Most of us are used to a little bit everyday. That's not how this works.
You're talking about multiplying every day. And so three days late, and if it's multiplied by 2 every day, you're now talking about a factor of 8 difference. And at the height of this epidemic, we were talking about a doubling time of every 2 and 1/2 days. So in five days, you're now talking about four times as much virus. And so you're already looking at data that's old and giving you multiples difference from what you actually have.
The second thing I want folks to appreciate is that science is not a book of knowledge. Science is a process by which we ask and answer questions. The coronavirus-- the SARS-CoV-2 virus-- has only been in humanity now for a little bit less than a year. And so it's really hard to know a lot of things about this virus until you actually start studying them.
And so in the early days, we were hustling trying to understand just very basic questions. And one of the big questions that came up was, is this transmissible by people who have yet to have symptoms or who don't have symptoms at all? And it led to a very different set of recommendations about masking in the beginning, and then we saw that change 180 degrees.
Now, we know a lot more, thankfully, about this virus now than we did in the past. And much of that is because good science has been done. We know that this virus can be transmitted by people and is likely to be transmitted by people who don't have any symptoms at all. We know a lot more about the clinical syndrome and about when people get symptoms, about how those symptoms work, about who is most likely to have severe symptoms, about what the longer term symptoms can be.
And most of all, though, we know what it takes to prevent it. And that means that, you know, the kind of lockdowns and school shutdowns, the kind of social distancing that all of us have come to understand and know, but some of us sometimes don't do as well as we might want to-- wearing masks, washing hands, making sure that you're six feet apart from folks, making sure to choose outdoor activities rather than indoor activities, and avoid crowded places-- those are things that we know work. We think that in some of the most affected areas, upwards of 20% of people may have been infected with this virus at some point or another. In communities that are less dense, in communities where the virus has not hit as hard, you're looking in the single-digits.
Now, the important thing to remember here is that there is a conversation that we're having about this idea of herd immunity-- about the probability of getting sick or not getting sick as a function of other people who may be carrying immunity to the virus because they might have had it. And we're nowhere near that right now. And so it's really important that folks really tuck in to these basic social distancing measures, because, unfortunately, it's plausible that the fall could be even worse than what we've already seen. And we've got to protect ourselves, our families, and our communities.
SOLEDAD O'BRIEN: We'll talk more about the second wave coming up in just a moment. Brian, first, I want to talk about what we learned about public health generally-- what did we learn about public health, what it can do and the limitations of it?
BRIAN CASTRUCCI: Well, I think we've learned that when you chronically underfund public health, you risk the lives of hundreds of thousands of Americans. That's basically the takeaway here is that we've always known that the pandemic was going to be a when and not an if. And yet every year, we've cut public health.
None of this had to happen. Other countries have controlled this virus so much better than we have in the US. I mean, basically, what we've learned is the confluence of an underfunded public health system coupled with horrific federal leadership has really jeopardized our economy, our health, and our way of life.
SOLEDAD O'BRIEN: Oxiris, we heard Abdul talk a little bit about herd immunity. And I think this is another one of these topics that people get very confused about. Many people point to Sweden and their experiment, I would call it, in herd immunity, as a wild success, some people as a wild failure. Can you explain herd immunity, and also talked about that experiment. Did it work? Did it fail? What did we learn from it?
OXIRIS BARBOT: First, let me start off by saying that herd immunity can apply to certain conditions. We often talk about herd immunity with measles. And last year, we had an experience here in New York City with the biggest measles outbreak. But in a situation where you've got a novel virus that no one has ever been exposed to, where you know that thousands and thousands of people are dying, advocating for herd immunity is reckless at best.
From a scientific perspective, we want 60% to 70% of the population to have antibodies that provide some kind of protection toward that virus so that if anybody else in that community is introducing the virus, people are more or less protected, and it won't keep propagating. And one of the things that has become really painfully evident is that this virus is not behaving the way we would have anticipated.
Initially, we thought it was going to be transmitted like the SARS virus. It is a SARS-CoV-2. But in reality, it spread much faster. It is much more deadly than that. The second thing is, to the point Abdul also made, is the degree to which asymptomatic people are transmitting. And so with that in mind, and if you take into consideration the degree of underlying illness that's already in the US population, right-- most people that are at risk for death from COVID have underlying obesity, diabetes-- those two are the main drivers.
70% of the people in the United States are either overweight or obese. And so, again, advocating for herd immunity, while on the face of it if you think about science in a void might make sense, in the reality in everyday communities, it's a recipe for disaster.
SOLEDAD O'BRIEN: Abdul, when I look at the numbers around school children, and I was very anxious to see these sort of-- and I'm talking about public school children-- I had thought they would be bad. Indoors, they're young, they're not so great about being compliant with washing hands and masks. And actually, I know here in New York, the numbers have actually been OK-- good, even. Can you explain to me what you think we're learning from that?
ABDUL EL-SAYED: So usually when you're talking about a major infectious disease epidemic-- a pandemic-- some of the hardest hit people are our youngest people. Of course, their immune systems aren't as well developed as adults are, and that can be a real cause for great concern. You think about any flu epidemic and the folks you're worried about tend to be young people, people in the ages of, like, 20 to 30, and then seniors.
One of the important things we've learned about this coronavirus-- and, you know, as a father, I'm really grateful for this-- is it just doesn't seem to be as infectious and as likely to cause severe illness among children. That being said, there's a lot of people pushing this argument that children are immune. That is not true. We've seen a lot of evidence to the contrary of that.
There was an outbreak at a sleepaway camp in Georgia that affected children. It's just that they're just less likely. The other part of this is also that I think schools are doing their best to keep children safe. That being said, the major caveat here is it's still early. And oftentimes with coronavirus, you start slow, and then because of that exponential growth we talked about, things can accelerate pretty quickly.
And we've seen in other states that schools have been a real space for outbreaks. What is critical and whatever folks choose to do with their kids and whatever administrators choose to do with respect to their schools, it is critical that schools facilitate following social distancing guidelines and that you work with your children about why it's so important to wash their hands, why it's so important to stay away, why it is so important to wear a mask, and really help them to understand what's going on.
That said, I think all of us should be very grateful and very thankful. As a father of a toddler, I'm really grateful that my nearly three-year-old daughter is not in the high risk zone. Because I think all of us know that our children are the people that matter the most to us and we worry the most for, for whom we're most responsible. But that doesn't mean that they're immune, and that doesn't mean that we shouldn't take the best social distancing guidelines and make sure that our children know why they're practicing them, how to practice them well, and that we model those practices for them.
SOLEDAD O'BRIEN: Brian, it seems to me that wearing a mask is sort of basic, non-controversial, and yet, there is so much conflict and viral videos around people who refuse to wear masks or don't even understand why they should wear a mask. So I want to talk for a moment about the public health strategy around mask wearing.
It makes a big difference, right? I mean, science knows this as fact. What will public health do in order to move that out of a political debate and into a basic wash your hands, wear a mask?
BRIAN CASTRUCCI: I think state and local health departments and their leaders have been pushing that from the get-go, right? We know to stay away from other people, we know to socially distance. We now adopt mask wearing, handwashing-- these are all basic public health practices. The problem comes really at this time and in this country, where the President of the United States has just disobeyed every single order you would like to think.
He did not wear a mask. He has held mass gatherings. He told the United States that, don't worry about COVID. It's not a big deal. And it's really hard for public health leadership to succeed when the president, the greatest leader in our land, is undercutting every message that we have. And this is just another example that elections matter and political leadership is important.
What's happened to the CDC as the world's leading public health authority, they have been undermined, they have been under partisan influence. And we have to take this moment to really think about how we want to handle health going forward. I think there's an opportunity for us to ensure that we will never have a moment in our history when health is at the whims of partisanship.
It happened in 1980 with Reagan. It happened around breast and cervical cancer and abortion with Bush. And it's happening now with Trump. And we need to make sure that partisanship on either side is not what's dictating our health, but that well-informed science is leading the way.
SOLEDAD O'BRIEN: Let's turn and talk about the second wave. Oxiris, are we in the second wave? What are the signs of the second wave? Is it just data first, or is there something else that you're looking for?
OXIRIS BARBOT: So we look at the data to tell us where it is that we are on the curve in terms of keeping the number of new cases at bay. You know, one of the things I've been thinking about is that we are such a large country, and we have had such a diversity of approaches to-- unfortunately, a diversity of approaches-- to tackling the virus that we can't say with one fell swoop the entire country is still in the first wave, the entire country is now in the second wave.
SOLEDAD O'BRIEN: Abdul, what are you worried about as we head into the winter months? What are you concerned about?
ABDUL EL-SAYED: Yeah, I'm concerned about a couple things. As Oxiris rightly pointed out, we are in a situation where the structural features of the way we live life in the colder months are going to increase transmission, simply because our ability to choose outside versus inside goes down. The return to school and college have not helped the situation. And we're spending more time together in close quarters. And that just increases the probability of transmission.
And we know enough if we were able to take what we know and actually exercise it, to protect ourselves from this. But the evidence suggests we're actually not doing it. If you look at the last 14 days, and bio-transmission is up 21%. And you know, last week, it was up 13%.
And so we're starting to see that acceleration-- right, we're not talking about a little bit every day, we're talking about the potential for a slow start upwards into a sharp transmission. And it looks like we're headed in there. Most of all, I'm worried about pandemic fatigue. I'm worried that people say, well, you know what? I've been there, done that. We spent almost a year worried about this thing, and I'm just done with it, come what may.
And the worrisome thing about this is that what may come may be a lot worse and has the potential to be a lot worse than what we've already seen. And so, you know, we've got to get the word out to folks that this is not the time to let up. This is the time to tuck in. We've got to protect ourselves, protect our families, and recognize, however annoying it is to wear this thing on your face-- it's not like wearing a motorcycle helmet. Do I want to protect myself or do I not?
No, it's, do I want to protect the people I care about and love most who I see most of all? Because that's how we have to think about it. So this is not the time to let up. This is the time to tuck in. We have an opportunity to get through this and save many, many lives.
SOLEDAD O'BRIEN: Oxiris, I'm going to come back to you for a second, because in the discussions, you often hear people saying, well, look at deaths-- as if somehow death is the final answer in terms of how we're doing as opposed to looking at some of the other measures-- not only cases and new cases. It seems to me that there's a lot of unanswered questions about the long term effects of coronavirus, right?
OXIRIS BARBOT: Absolutely. And so one of the things that we know is, yes, the majority of people will have quote unquote "mild cases" and won't need to be hospitalized. But what we don't know is the degree to which they will have long term consequences as a result of the infection.
I think one of the examples that comes to mind is the MSIC-- which is the Multi System Inflammatory Syndrome in children. Where a week after having had a potentially mild case, they then present with very severe illness and require hospitalization. The degree to which these children will have long term consequences of their heart, of their kidneys, et cetera, we just don't know.
The other thing that I will say is, you know, we're hearing more and more about people who are being referred to as, quote unquote "the long haulers"-- people who may have somewhat recovered from COVID, but yet still suffer from fatigue, from what we're hearing referred to as brain fog-- again, things that may not result in death, but will result in disability and people's ability to re-engage in quote unquote "normal life."
And so part of what I remind folks is that when public health advocates for the use of face coverings, we're not trying to restrict people's individual liberties. We're actually trying to advise on ways in which they can fully exercise them safely.
SOLEDAD O'BRIEN: Yeah, I think the drama around face coverings is so out of control, it's not even funny. From a public health perspective, Brian, how do you deal with pandemic fatigue, as Abdul calls it? Because I see it my kids. I think they're just sick of being stuck in a place without their friends. And I see it in my colleagues-- people want to go back into the office and start getting work done there. What's the best strategy for-- is it just wait because there's going to be a vaccine? Is it just keep putting multiple masks on and keep washing your hands? What advice would you give?
BRIAN CASTRUCCI: I think it's just to remember that we are staying apart now so that when we can gather again, everyone is there. If you don't want to wear a mask, if you don't want to socially distance, next time you gather with your family, pick the person that you don't want to be there anymore. That could be the person who gets COVID and has a negative outcome.
And while we may be waiting for a vaccine, a vaccine very much feeds in to our quick fix culture. Just getting a vaccine will possibly solve this crisis, but the vaccine will likely lead to less interest in funding public health. And if we don't make that decision at this time, then we are openly accepting vulnerability to our economy, our national security, our families, our loved ones.
This is not something that we should just wait for the vaccine. We need to ensure that we are fortifying and funding our public health system. I know it's not the sexiest topic, and a lot of people don't even know what public health does. But just look at the deaths-- and we've mentioned the number-- 200 and some odd thousand. That's just so far.
So remember, if you are someone who's watching football, that so far, two entire stadiums-- like the Eagles or the University of Texas or the University of Ohio-- that's the entire stadium twice is the number of people we've lost. If that doesn't get you to socially distance or wear a mask, I don't really know what would.
SOLEDAD O'BRIEN: Abdul, where are we with testing?
ABDUL EL-SAYED: Unfortunately, this has been the story since the beginning of the pandemic. Testing really could improve a lot. And it's frustrating, right, because, you know, the extreme example of what you shared, Soledad is the NBA, right? They established an entire bubble where people were tested at random every day. And they were able to keep their bubble COVID-19 free.
What that shows us is with very, very strict social distancing and regular testing, it can be done. The challenge is not, we have been behind from the jump on testing in this country, and because we've been behind the jump and there hasn't really been federal leadership to either ascertain and procure the testing that we needed and/or to provide really thoughtful public health evidence-driven testing protocols across the board, it has been a bit of a free for all.
And so, you know, in some circumstances, in some states, in some communities, it's really easy to get testing. In some, it's a lot more difficult. And because we have so many different tests-- different, you know, timing in terms of one-day results, different measures of sensitivity and specificity which are fancy ways of saying how good are the tests-- it has really created a bit of a jumble. We need high quality testing. We need a lot more testing than we have. We need a rigorous federal protocol for how we deploy testing.
And there should be no circumstance where anyone in this country feels like they need a COVID-19 test and cannot get one. It shouldn't be a matter of how much money or how much capital you have behind your institution. And most of all, we have to remember that-- and we haven't talked about this yet-- but the communities that have been hit hardest by COVID-19 have been black and brown communities. And that has everything to do with differences in resources, nothing to do with differences in genetics or biology-- but everything to do with a whole set of historical structural differences in access to basic resources, health care being one of them.
And so without being able to do this at scale as a country, what we have done is left the poorest Americans who are disproportionately black and brown because of the history of this country without the testing that they need. And you know, we can do better and we must do better.
SOLEDAD O'BRIEN: It's a good point. And, Oxiris, maybe you can pick up on this, because resources are so connected to outcome. And early on in the conversation about coronavirus as a whole, we talked a lot about PPE, right-- do people have just the gear to protect themselves. Is there a second wave? Are you confident there's going to be a second wave? Has that conversation shifted at all? Will we not be having it again if, in fact, there is a second wave?
OXIRIS BARBOT: So we're guaranteed to have a resurgence, right? There's going to be an increase in the number of cases. To what degree that, then, is going to affect cities is going to be dependent on individual behavior, but then also on systems. And you know, I think we've learned a lot about the PPE that's needed, who needs N95, who needs surgical masks, who can use cloth face coverings.
And I know that in New York City, there's been a lot that's been done to ensure that the entire spectrum of health care delivery-- and the reason why I say spectrum is because I think too often we forget about home health aides as part of the health care delivery system. And that's an area where we fell short in the early parts of the pandemic.
And I want to make sure that they are incorporated into second wave planning, because as we fight to keep more people out of the hospital, we need to ensure that our essential workers, including home health aides, including people who are part of our food delivery system, are maintained safe.
SOLEDAD O'BRIEN: Brian, I'm going to give you the final word. I'm curious if you're optimistic about what is coming down the pike at us, both in terms of just the second wave of coronavirus. Will it be less? Will we be able to manage it better?
BRIAN CASTRUCCI: When I think about our conversation, we focused a lot on the pandemic and the virus. As we have a resurgence in cases, we now have a pandemic wrapped in a housing crisis wrapped in an employment crisis wrapped in a mental health crisis wrapped in a livable wage crisis.
We have so many crises right now. The pandemic has illuminated disparities that were always there, but are now impossible to ignore. What I know is that every decision that we make from this point forward is going to define how we deal with COVID, what type of society and community we want, and whether this will ever happen again.
SOLEDAD O'BRIEN: Brian Castrucci and Oxiris Barbot and Abdul El-Sayed, thank you for joining me for this conversation. Really appreciate it.
ABDUL EL-SAYED: Thank you, Soledad.
BRIAN CASTRUCCI: Thank you.
OXIRIS BARBOT: Thank you, Soledad.