Podcast: Lessons Not Learned: America's Pandemic Response with Vivek Murthy

TRANSCRIPT: Lessons Not Learned: America's Pandemic Response with Vivek Murthy

Vivek Murthy:

Everybody, all of us, myself included, we want to get out. We want to see people again, but that's why we need our government to act quickly and effectively to shorten this pain as much as they can.

Ian Bremmer:

Hello and welcome to the GZERO World Podcast. Here you'll find extended versions of the interviews from my show on public television. I'm Ian Bremmer. And last week President Trump resumed daily coronavirus briefings as outbreaks surged across the nation, particularly in California, Florida, Texas, and Arizona. As we enter the dog days of summer, there are still so many unanswered questions about what awaits us this fall. Will schools reopen safely? Probably not. And how does America get back to work without drowning in a second wave, while we're still on the first? My guest is former Surgeon General Vivek Murthy. We are also talking about another pandemic, one he believes is just a serious loneliness, and how quarantine and social distancing are impacting mental health in the United States and around the world. Let's get to it.

Announcer:

This episode of the GZERO World Podcast was made possible by Lennar, America's largest and most innovative home builder, and the number one destination for foreign residential real estate investment in the US. Learn more at www.lennargzero.com. That's L-E-N-N-A-R-G-Z-E-R-O.com.

Ian Bremmer:

Dr. Vivek Murthy, our nation's 19th Surgeon General. He's still younger than I am. It kind of annoys me, but I have to deal with it. You're from New York, but you live in Miami now. Are you just following the epicenter of the epidemic? Is that's what you're on about now?

Vivek Murthy:

Well, not intentionally at least. Normally my wife and I and two kids, we live in Washington DC but we came down to Miami in March actually to be with my parents and my sister and brother-in-law and grandmother who all lived here. This is where I grew up. So at the time, Miami wasn't so bad, but it's quite bad right now and it's one of the epicenters in the country.

Ian Bremmer:

A lot of polarization around how governor DeSantis is responding. I'm seeing that ICUs not far from you right now are overflow. How does it look?

Vivek Murthy:

Well, Florida is in bad shape. We are, unfortunately, seeing the numbers skyrocket here. And in particular, it's the test positivity rate. The percentage of tests performed that are positive. That is deeply concerning. You normally want that number to be below five, but I'll tell you that, where I am in Miami-Dade County, right now is as far as recently as a week ago, we had test positivity rates that surged above 30%. That's unheard of. That is an extraordinarily high number.

And what that tells us is that the amount of infection in the community is quite significant and that it is in fact growing. So there are measures that have been taken in some counties. In Miami, for example, there is a mandatory mask order to wear masks in public. They have also taken some steps to close on bars and indoor restaurants, but that those measures need to be taken across the country. And unfortunately, what we're seeing in the case of Florida, is that we're still waiting too long here and just trying to pause reopening at a time where we really need to be aggressively pulling back if we want to get this virus under control.

Ian Bremmer:

Specifically, I remember in Lombardi, in northern Italy when the hospitals got overwhelmed, that's when mortality really spiked. Here in New York City, we came close to that, never quite hit. Is that a possibility in South Florida in the coming weeks?

Vivek Murthy:

Well, we certainly hope it won't get to that, but yes, that is a possibility. We have seen hospitals and ICUs fill up in many parts of Florida, including here in Miami, Florida. And there's a lag between these different events when it comes to Covid-19, and that's really important to understand. First what happens is people go out and they get exposed. For example, Memorial Day weekend, we had a lot of activity and people were out and about. They were engaging with others, there was exposure. And then sometime after that, some period between two to 14 days, people will develop symptoms and after that they will go to get a test. They may have to wait several days, sometimes up to a week to get the test results.

Then we'll see ER visits and hospital stay rates go up and then after that, a week or two after that, we will see death rates go up. So there is this long lag that happens, and even a few weeks ago, people were saying, "Oh, this isn't that serious because deaths are continuing to go down." But what many of us recognize and would've been talked about for weeks was that those deaths were going to go up and that's what we're unfortunately seeing now.

Ian Bremmer:

Death rates... We've had a number of days of well over 10,000 cases in Florida, which a number of days of well over a hundred deaths, but fortunately, that death rate is nowhere close to what we had in the New York City broader metro area. In your view, is that largely because it's a much younger spread and you don't have, for example, the assisted living concerns that you did in New York? Is it because it's too early and you're likely to get the demographics going up? Are older people just being a hell of a lot more cautious because they know better at this point? What's your view?

Vivek Murthy:

I think there are a few things that are going on in our favor. One is that there is more awareness that this is a serious issue and that it's critically concerning for those who are elderly. And so I do think people who are older, many of them are taking more precautions than perhaps they were in March. We also know more about how to handle this virus when it comes into the hospital. We recognize, for example, that using a high flow oxygen, as opposed to intubating early, is a better strategy. We have dexamethasone, a steroid, which we now understand can be helpful for reducing mortality. We have Remdesivir, which doesn't necessarily reduce mortality, but reduces hospital stay. So we do have a few more tools, nothing that's a game changer, but a few more tools. But my concern is the following.

Unlike what happened in March in New York, we are now seeing rapid spread in many states. Not just a couple, but in Florida, Arizona, Texas, South Carolina, Southern California, and the list goes on. What we're also seeing is that even though there's a greater portion of young people who are affected now, and even though young people have fewer complications than older people, although not zero complications, that will ultimately, unfortunately, change because the more younger people get affected, the more older people they will expose. So we've got to recognize that in with the Covid-19, even though we know a lot about the virus, we're still learning a lot and we've got to be cautious. We can't assume the young people aren't at risk. We can't assume that just because kids seem to do better, that we can open up schools and not worry that infection isn't going to spread.

Ian Bremmer:

A lot of substance there. I want to dig into a few different pieces. One, in terms of the tools, oxygen at high density as opposed to ventilators. Does that mean knowing what we know now, if we had known that earlier, the effort to get thousands and thousands of ventilators manufactured and shipped and the fact that we didn't have them in a lot of places... Could that have all been avoided if we had just known how to treat this thing?

Vivek Murthy:

I don't think all of it could have been avoided because I think that it's still the case that ventilators are useful in certain circumstances, but what we recognize is that if we use high flow oxygen earlier in the course of illness, we may be able to avoid intubation and needing a ventilator, but that will inevitably still be the case that we will need that, from time to time. So recognizing that we had a shortage in mobilizing those resources was not the wrong thing to do. Unfortunately though, what I worry about, Ian, is that we're not still heeding many of the lessons that we learned from New York. What New York taught us is the following. It said that we've got to make sure that our hospital systems have the equipment, the materials, and the support in terms of person power to ensure that they can handle a search.

Today, we are still seeing hospital systems across the Sunbelt and the country that are struggling without protective equipment. We also learned from New York's ex experience that testing is critical. See, testing is like our eyes. It's what lets us see where the virus is. If we can't see, we can't contain the virus, we can't contain it. It will continue to spread. We unfortunately did not learn that lesson, and while we have improved somewhat modestly in testing, we have nowhere near the amount that we need. And so what you see right now is that people are waiting for hours and hours in lines to get tested, and many are actually turning back. We're seeing that the amount of time it takes for a test result to come back is also stretched to 8, 9, 10 days, at which point it actually becomes useless.

Ian Bremmer:

At which point, you can't use anything. Yeah, we're on the same path here. Another point on the tools you were talking about, the fact that it looks like Remdesivir is useful as a treatment. I have seen the Trump administration buying up almost 100% of the global distribution capacity of Remdesivir internationally for the next six months. If you were surgeon general now, would you be recommending that that is the right course of action for the United States? Is this sort of national security uber alles, or is there a better path?

Vivek Murthy:

Well, I think that we have to put all of this in perspective and to recognize that Remdesivir, while it's an arrow in our quiver, it is not a game changer. It's not a silver bullet. And in fact, if you look at the data on Remdesivir, what it tells you is that it modestly reduces the time of hospitalization for people who are hospitalized and severely ill, right? That's actually a small minority of people. So is it useful? Yes. Does it make sense to make it the linchpin of our Covid-19 strategy and to make people think that because we have Remdesivir, somehow we've solved this problem? Absolutely not.

What I would do instead is I would focus my efforts on, number one, reducing the amount of infection we have, and you do that by ensuring there's universal wearing of masks. You do that by reducing and pulling back on physical interactions, and you do that, in part, by also communicating effectively and with one voice consistently to the public about this illness. What we've seen unfortunately though, is that the communication has often been either misguided or conflicting, and so people have taken away different messages. We've also seen a response effort that has been unnecessarily politicized, and as a result, masks have become a political symbol, whereas they are, in fact, a public health intervention that could save lives.

Ian Bremmer:

Let's get into that politicization and the mask-wearing, because on the one hand, your successor, Jerome Adams, has been going public saying, "Please, I'm begging everybody, please wear a face covering." On the other hand, in early days, we saw the CDC, we saw the World Health Organization, we saw Dr. Fauci all saying that they weren't so sure about mask wearing. Some of that conservatism and concerns about Americans going and panic buying and there wouldn't be enough masks available for frontline workers. How do you balance that? Because I mean, if you're saying one thing and then you're saying something else a few months later, you can imagine even with the best of intentions, Americans are going to say, "What the hell should I believe?"

Vivek Murthy:

Yes, and I can absolutely appreciate that. And listen, you have to remember these kind of pandemics, is that you are both trying to put an action plan in place while you're actively trying to learn about the virus at the same time. And sometimes that means that you're going to learn new things that change your guidance. But Ian, this is why it is absolutely essential that you communicate honestly, openly, and transparently throughout a pandemic response. Because what you are doing when you do that is you're doing more than giving information to people. You're building public trust. And it turns out that in a pandemic response, one of the most important assets you have is public trust. And if you allow it to fritter away because you either communicate inconsistently or you don't explain to people why you're recommending what you're recommending, then what you end up with is a situation where people are not only distrustful, but they may not do the things you advise them to, even though they're the right thing to do.

And here's where I'm worried about it. Today, we know we are working on all fronts to develop a vaccine for Covid-19. Yet recently, polls showed that nearly 50% of people when asked if they would take that vaccine if it was available today, said no. Now, why is that, when we know how powerful the impact of this virus already has been, economically, in terms of our health? And it's not just people who don't have faith in any vaccines. It's many people saying no, who already take other vaccines but are worried about how this vaccine is being developed. Now, why is that coming about? It's coming about because public trust has been damaged. And so we've got to remember, at all points when we communicate, that it's okay to change your mind and your guidance as you learn things. That's going to happen. And it's going to happen, that you're going to stumble, that you're going to make a mistake. What matters is how openly and honestly you're you communicating with people and are you learning from your stumbles? And that's really the key here.

Ian Bremmer:

When we talk about the vaccines that are coming, and we know a lot of vaccines are under various stages of development right now, in China, they have vaccines that are still in earlier stage trials, but they're giving them to Chinese military to take for data that they're probably not going to share. In Russia, scientists actually gave the vaccine to themselves, this early stage. Doctors really don't like it when they do that. I mean, here in the United States, we have an election coming up in November, and what happens if vaccines are sort of looking like they're promising, but they're not where you would suggest, but Trump, the president, comes out and says, "Well, yeah, we should make this vaccine work. It's successful." How do we avoid a whole bunch of people in the United States, at that point, saying, "I don't know if I want to take this vaccine because I don't feel..." Nevermind the anti-vax movement, that's a different problem. But simply because it's not clear. Different sides are saying different things for different reasons.

Vivek Murthy:

I think you raised a really good point, and it's a point I'm deeply concerned about as well. When we already have enough challenges with people understanding and the science behind vaccines, we cannot afford to allow the development and approval of a vaccine to be further politicized. And what that means is that if we come to the point, which I hope we will as soon as possible, where we have enough evidence to support a vaccine as being both safe and effective, and what's got to happen is that we make that data readily available so the public can see it as well, so that independent scientists can vet that data. And we also have to be very transparent about the process for issuing an approval. Because the stakes are high here. The risk of getting that decision wrong, and God forbid, pushing forward an approval for political reasons could be disastrous if it turns out that it is not as good as what we said.

If it has more side effects, because we didn't get the safety data we needed, then that could damage trust in the vaccine development process for years and years to come. And that's much too high a price for us to pay. There's one more step beyond developing the vaccine, which is important, and that's actually distributing the vaccine. And I want to be very clear on this, that this is no simple thing to do and it doesn't happen quickly.

So because we get a vaccine approved, let's say, today, doesn't mean that next week or even next month, everyone is going to have it. What's going to have to happen is we're going to have to have a tiered structure where we prioritize people on the front lines, people who are at higher risk, like the elderly. And we also need in an incredibly well-thought-out and coordinated network of partnerships between schools and hospitals and clinics and workplaces, as well as the local and state and national government, to ensure that we are distributing getting the vaccine delivered to people as quickly as possible. In the best case scenario, that can take several months to do. In H1N1, it took us many months to get the vaccine just to a third of the population. So we've got to keep that in mind. And that's something that the administration should be mapping out and planning right now.

Ian Bremmer:

I'm hearing a lot of people saying that the first vaccines that work, if we're talking about vaccines for flus, they're also not silver bullets, right? They don't get everybody. They're not successful in all cases. So even once you have distribution, it's not like suddenly, everyone's back to work and it's fine.

Vivek Murthy:

That's right. And some of the things that we're trying to figure out now is what kind of vaccine we'll get at the end of this. We might get a vaccine that helps some people, but not many people. We might get a vaccine that requires a couple of doses to get you up to a protected level, which will make the logistics more complicated. We may get a vaccine that does pretty well, but the immunity only lasts for a year, in which case people need to get it every year. Only time and the science will tell us what kind of vaccine we end up with. But the good news is that we have a number of vaccine candidates that are actually in advanced stage trials right now. That's good. We have people all over the world in the public and private sector working together to develop this vaccine. And it's happening at a remarkable pace, in part because of this collaboration and in part because of technology we have now that we didn't have 5, 10 years ago.

Ian Bremmer:

I want to turn to the other side because before the pandemic hit, you were making a name for yourself, writing about the dangers of the loneliness pandemic, the mental health issues that were affecting all of these people in the United States and around the world because they weren't connected socially. Because we were bowling alone, as Bob Putnam used to say in my field. Now it's much worse, exponentially. Everybody's now stuck in their homes. What do we do about this? How unhinged is our country going to become?

Vivek Murthy:

I never imagined when I wrote the book on loneliness that this would be where we would be. Because even before Covid-19, we were actually struggling with extremely high levels of loneliness and disconnection in society, not just in the US but in countries around the world. We have more people who admit to struggling with loneliness in America than have diabetes or who smoke. But the real concern here also is that it's not just a bad feeling, but we know that loneliness has held consequences, that people who struggle with loneliness are at increased risk for premature death, for heart disease, dementia, depression, anxiety, sleep disturbances, and the list goes on. So my worry with Covid-19 is that the physical separation that we've been asked to endure, the stress that so many people are under without the ability to get together with their close friends, that will take a toll on us, mentally and psychologically.

And in fact, for some people, and for many people if we don't do something differently, that physical distancing will convert into social distancing and a deeper loneliness. It would essentially create, as I think of it, a social recession. And that I think could be just as consequential as the economic headwinds we may be facing. But I don't think that we're destined to go in that direction. I actually think we can choose a second path, which is not the path of social recession, but the path of social revival. That we can use Covid-19 as our opportunity to step back and take stock of our lives. To double down, in fact, on our commitment to the relationships in our lives, to double down on our commitment to people. Then we may be able to come out of this stronger than we were before. And we can do that in simple ways.

We can, for example, make it a point to keep 15 minutes each day when we're actually connecting with people we care about. We can make sure that the quality of time is high, that we're not distracted when we're talking to the people we love, but that we're actually giving them the gift of our full attention. We can make it a point to seek out others with opportunities to serve and help them, recognizing everybody is suffering in this moment of a people but also that service is one of the most powerful ways that we can help address loneliness. It's an antidote, if you will, to loneliness. So even though we can't physically see each other in the ways that we could, we can still connect in these ways. We can be intentional about it, and we can help build a foundation for deeper connection so that we can come out of this pandemic more resilient, healthier, and more deeply connected than we were before it began.

Ian Bremmer:

I mean, clearly the digital issue, the fact that so many people in the United States are so used to being with their friends, very convivial, going to bars, going to restaurants. They've been locked down for a few months. You tell them, finally, "Okay, have at it." And then, "Oh, no, no, you've got to back away." Now, kids... They need to be engaged at school, and we know distance learning is going to be a tiny shell of... And they're stuck in their screens no matter what. How do you this and not just revert to algorithmic non-citizen-to-citizen engagement?

Vivek Murthy:

This is really tough, and this feels very personal for me too. We just found out that our son, who is really excited to be beginning an elementary school, is not going to be able to go to school in the fall because they've delayed opening and they're doing distance learning because of Covid-19. All of us, in some way, shape, or form, whether it's our kids or the kids that we know are being affected by this school closure. But the truth is, if we look around the world, Ian, we have not seen another country that has attempted to open up schools with this degree of spread of coronavirus. I mean, it is almost madness to think about trying to open up a school in Miami-Dade County right now, for example, with so much virus in the environment and recognizing that it is not just about kids getting sick, it's about kids also transmitting the virus to teachers, to administrators, to parents, and others at home.

So there are real challenges we have when it comes to schools, but all roads run through getting the virus down in our communities. That's why the measures we've been talking about in this conversation around masking and distancing are so extraordinarily important. And if we do them, and do them right, we can actually shorten the duration of pain. What we're, in fact, doing in the United States is we're stretching it out, because we're not fully committing to taking these measures because we're not using that time that people bought us when they stayed home. In order to develop testing and contact tracing, we're actually prolonging the pain. And what that means is that people can't go out for longer. Schools can't open for longer. People don't have infinite patience, right? Everybody, all of us, myself included, we want to get out. We want to see people again, but that's why we need our government to act quickly and effectively to shorten this pain as much as they can.

Ian Bremmer:

Dr. Vivek Murthy, our former Surgeon General, wonderful to be with you, sir.

Vivek Murthy:

Thanks so much, Ian. Great to be with you too.

Ian Bremmer:

That's it for today's edition of the GZERO World Podcast. Like what you've heard? I hope so. Come check us out at GZEROMedia.com and sign up for our newsletter, Signal.

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This episode of the GZERO World Podcast was made possible by Lennar, America's largest and most innovative home builder, and the number one destination for foreign residential real estate investment in the US. Learn more at www.lennargzero.com. That's L-E-N-N-A-R-G-Z-E-R-O.com.

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