Factually! with Adam Conover - Public Health and the Pandemic Two Months In with Dr. Josh Sharfstein

Episode Date: May 13, 2020

We're two months in to the pandemic, and some states are starting to reopen. Are we anywhere close to where we need to be to do so safely? Dr. Josh Sharfstein, current Vice Dean for Public Health Practice at Johns Hopkins and former principal deputy commissioner of the FDA, joins Adam to discuss the state of our fight against the pandemic, the importance of public health to our communities, and reinventing the world we used to know. Learn more about your ad choices. Visit megaphone.fm/adchoices See Privacy Policy at https://art19.com/privacy and California Privacy Notice at https://art19.com/privacy#do-not-sell-my-info.

You know, I got to confess, I have always been a sucker for Japanese treats. I love going down a little Tokyo, heading to a convenience store, and grabbing all those brightly colored, fun-packaged boxes off of the shelf. But you know what? I don't get the chance to go down there as often as I would like to. And that is why I am so thrilled that Bokksu, a Japanese snack subscription box, chose to sponsor this episode. What's gotten me so excited about Bokksu is that these aren't just your run-of-the-mill grocery store finds. Each box comes packed with 20 unique snacks that you can only find in Japan itself.

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So if all of that sounds good, if you want a big box of delicious snacks like this for yourself, use the code factually for $15 off your first order at Bokksu.com. That's code factually for $15 off your first order on Bokksu.com. I don't know the way. I don't know what to think. I don't know what to say. Yeah, but that's alright. Yeah, that's okay. I don't know anything. Hello, welcome to Factually. I'm Adam Conover and let's talk pandemic, right? Let's do it because we are still in it. And I'm going to be brutally honest with you, OK? Things are not, quote, going back to normal anytime soon. You know, all those tweets you see like when this is all over, I'm going to get all my friends together and we'll all get in a big pool and drink white claws and touch each other's faces. I can't wait for that day to come. Well, that day is not coming. COVID-19 is an event as seismic in our lives as September 11th or Pearl Harbor. Okay. There is no winding the clock back and just going back to the way things were before. We live in this world now and this world is going to be different from the old

one forever. And I know that's bleak. I know that's a bleak thing to say to you, but I do want to stress that that doesn't mean that things are going to be like this forever, right? Things are going to change, and hopefully they're going to change for the better. And I have to be honest, it seems like we've started to move into a new phase of the pandemic, right? Things have started to change kind of. The beginning of the pandemic is over. We finished the first inning, right? Now we're in the second inning. And we're starting to realize that this baseball game is a lot longer than we thought it was. And that it's also the shittiest baseball game America has played this century.

So things are moving, but we're in it for the long haul. What we need to ask ourselves now is how does that long haul look? How do we feel about how things are going moving forward? And I have to say, I am an optimist generally. I very much am. But I would have to say that the state of things is still very bad. America, just to remind you, has had more confirmed cases and deaths than any other country on Earth.

We are doing the worst in terms of the numbers. 80,000 Americans have died of coronavirus and over 1.2 million of them have been infected. died of coronavirus, and over 1.2 million of them have been infected. But given how scant testing has been, the true numbers are much higher and they are guaranteed to grow. And they have not been evenly distributed through our society. An analysis last week found that while African Americans make up about 13 percent of the U.S. population, they have made up about 27 percent of COVID-19 deaths. They're wildly disproportionately represented in the data. And almost a third of American coronavirus deaths have been nursing home residents and the people who work there.

A third of deaths have been the elderly and the folks who care for them. Grandparents like yours and mine. Low income Americans are also overrepresented in the fatality statistics. Now, there are some states that have made an effort to try to protect the most vulnerable cities like New Orleans and New York and states like California have attempted, for instance, to to place their homeless neighbors into vacant hotel rooms to wait out the crisis. Of course, in California's case, that effort has been woefully inadequate, with only a small fraction of people needing shelter actually being helped. You know, they haven't wanted to commandeer whole hotels. Instead, they just ask,

would you voluntarily give us a few rooms? And so they end up only voluntarily housing a few people, not the massive numbers of folks who are affected who need to be protected. So altogether, it does not seem like the states and cities are doing a very good job of protecting the most vulnerable. Instead, it seems like this pandemic is just heightening and exacerbating the exact same massive inequities baked into American society that were already there. But OK, how are we doing fighting the disease? Well, we are still way behind on testing, way behind. Last week, researchers published estimates showing that if the United States wants to contain the outbreak,

we need to conduct at least 900,000 tests daily by May 15th. You want to guess how we're doing? You want to guess if we're close to 900,000 tests daily? Not at all. We're about a third of the way there. That's it. Not in the ballpark so far.

And meanwhile, our government is still downplaying the need for testing altogether and saying we don't really need to have it. Great. Fantastic. Feeling good. Feeling good. Well, how about the vaccine? How's the vaccine coming along? You know, the one that will allow us to finally fully open things up once we're all vaccinated? Well, while there are promising clinical trials and a massive and inspiring international effort to develop a vaccine, the rosiest of rosy scenarios still would require 18 months for it. 18 months. And there's reason to believe it will take still longer.

So things aren't looking super hot moving forward. But, hey, despite this massive lack of testing, the lack of treatments and the continued virulence of the virus, its continued impacts on the most vulnerable among us, more than 35 states have started to reopen their economies. 35. Now, you might think this seems ill-advised, you know, given that more than a thousand Americans have died of COVID-19 every day since April 2nd. But look, let's be charitable then. Let's imagine that

they're not just trying to sacrifice lives on the altar of the economy. Okay, let's look at it through their eyes. If you're looking at the unemployment numbers, you might see why they are fucking panicking a little bit because the U.S. economy lost 20.5 million jobs in April, wiping out the gains made over a decade since the Great Recession. And unemployment is now the worst it has been since the Great Depression. The American economy of two months ago will not return for years, according to economists. So let's see. People are dying. We're not doing what we need to to fight the disease.

And the economy is in the shit. Or we are in the shit. We are in the middle of it now. And I understand we're all really concerned. We have a lot of questions. So, look, what we have done again, you might remember a couple months ago, our interview with Dr. Ashish Jha, who helped break down the virus for us and tell us what we need to know about it. Well, we've got another expert in that vein. Today, we have Dr. Josh Sharfstein. He's a vice dean for public health practice at Johns Hopkins Bloomberg School of Public Health, and he's a former deputy commissioner at the Food and Drug Administration and also the host of the Public Health On Call podcast.

because he has spent a lifetime devoted to public health. Public health, a field that we all realize is now very important, right? The public health workers are now the firefighters of current day, right? We realize that we need them more than anything. We need to understand this field. Well, Josh is the perfect person to help us understand what it is and why. Without further ado, please welcome Dr. Josh Sharfstein. Hey, Josh, thank you so much for being here.

Oh, well, thanks for having me. Last time I saw you, you were on set for an episode of Adam Ruins Everything, where you were on talking to us about the FDA and about supplement regulation, right? That's right. And you made me popular with my kids, which was really incredible. Yeah, you brought your son to the set. And I don't know, that's my that that has helped us book more experts. I gotta say is the promise that we can make experts look a little bit cool to their kids. Yeah, well, when I said I'd been invited, I mean, he lit up like I'd never seen. He said, I've seen every video on YouTube. And he was so excited. And truthfully, I mean, his tastes have changed over the years, but he speaks so highly of that

experience. And I hear him telling his friends and his friends, I guess it still plays in airports. I don't know, but his friends hear about it all the time. And for some reason, there's a deal where it plays on like, you know, the TVs that have CNN on when you're in the waiting area and you're like, God, why is it so loud? Like, just turn it off, please. There's a deal where sometimes those TVs play Adam Ruins Everything for some reason. Yeah, I am well aware because I get random calls and my son gets random calls from his friends whenever they see me. Amazing. Well, none of us are seeing any of those airport monitors very often right now because of the COVID-19 pandemic. And I wanted

to check in with you because I keep seeing your name pop up in interviews and articles about this. And you seem to have a pretty good handle on it in your role as a public health thinker. So I want to ask, where are we? We're currently recording this on May 6th. It'll probably come out next week. And it feels to me like things have started to change a little bit. We're starting to see states, some of the hardest hit states like New York and California start to put out reopening plans, et cetera. But I'm sitting here wondering, wait, has anything changed? Have we actually instituted anything that is going to

allow us to do that safely? And what are the next couple of years look like? Well, those are all really good questions. You know, usually when I'm talking about this, I start with just the basics, which is that we have a virus that no human being was exposed to, you know, going back five months or so. And now it has taken over the world. It's everywhere. And this is a virus, highly contagious. It's lethal, particularly to people who are older and with chronic medical conditions.

particularly to people who are older and with chronic medical conditions. And it unfortunately exploits all kinds of vulnerabilities in society. And the United States has really been hit hard. I think we've also learned that we have some tools, even without effective medicines and vaccines for fighting back. If we stay away from each other enough, we deprive the virus of a chance to jump from person to person. And that really can save lives. And, you know, there was a period where we were all very worried that our hospitals would look like Italy's in Northern Italy, and that, you know, people wouldn't be able to get care and they'd be rationing ventilators.

And I mean, that could well have happened, but people really heeded the call. And as a result, many lives were saved. It was obviously a terrible situation and a lot of loss of life. But, you know, we learned that we can turn the curve. And now we're trying to figure out where to go from here. So we're at the stage where the worst case scenario has been avoided, but we're not anywhere close to the best case scenario. We're still coping with a very contagious and lethal virus. And so we're thinking about the opening issue in two ways. When is it safe to start? And then how do you do it well so that you don't just cause another repeat of what we just had.

Yeah, that's the fear. Exactly. And the fear is real because really the only thing that's keeping the virus in check is that we're not in touch with each other. It's not anything else that's happening. We stay home, we wear masks, we stay six feet away. That's keeping the virus in check. I mean, when I when I think about it,

from my point of view, California has been closed for many weeks. My office has been closed. We've been working remotely. Right. And when I and, you know, there's certain retailers are opening again in California this week. And OK, so maybe we're going to start seeing things reopen. And I've been thinking, well, OK, what are they? What if they say what the governor says? Hey, workplaces like Adam Conover, like yours, you can go back to work. I'm going to be thinking, wait, what has changed to make it safer for me to go back to work? Because I still don't have any immunity.

I still don't have a vaccine. I still don't have any immunity. I still don't have a vaccine. I still don't have an additional treatment. There's still dozens of deaths in California a day and still many, many, many new infections. And so would for my own safety, shouldn't I keep staying inside? And for the safety of the people I work with, shouldn't we just stick to working over Zoom? Like that's the part that's confusing to me. Has anything changed? Those are good questions. And the answer I would say is if for your work,

you can work over Zoom, that is the safest thing to do. Now, if you need, you know, in order to do your work to be in physical proximity, then the goal is the minimal necessary. So it's a pretty low risk of infection if you're in a well-ventilated office and you're six feet away and you're wearing masks, say. That's a pretty low risk. So there are a bunch of offices that could open like that and never really see transmission in that setting. But I remember going on your set and I was impressed. I remember that

usually when I would do news interviews, it would be like a robot, you know, pushing the camera around. It would just be me and the, you know, just be, it'd be like this huge, you know, studio and just me and the host and a robot pushing the camera around. And then I went to your set and it was like 50 people crammed into a little space, you know, everybody with their own role. It was really amazing to watch, but like certainly couldn't do that with six feet in between everybody. No, it's impossible. I mean, television production of the kind that we do is like, it's like a basketball

game. It's like people are up on each other. People are sweating. People are squeezing by, you know, you're in very close proximity. And yeah, that's and I mean, you know, even just the office we're in now. Hey, comedy writers rooms. There's a lot of there's a lot of stuff being flown into the air. You know what I mean? You're you're being loud. You're laughing. You're jumping around. It's hard to do with masks on. It's yeah, it's difficult.

Yeah. So so those things all become potentially risky. Yeah. So those things all become potentially risky. And if one person were to get sick, everyone would be quarantined and there would be a pretty legitimate risk of exposure. You know, the risk isn't, it's not like you walk past someone or you're sitting with someone for a second, you get sick, but it's possible. And there are these sort of super spreaders where suddenly everyone gets sick and not a lot is known about that. So, I mean, there is a risk. So the best thing to do is to go remote wherever you can while we're in this period and to take as many precautions as you possibly can take. You know, if that's just not possible or you're deciding it's just too important to move forward, then you have to think about, you know, other ways to minimize the risk. I mean, people can basically isolate themselves for two weeks before they go and get engaged in something, you know, other ways to minimize the risk. I mean, people can basically isolate themselves

for two weeks before they go and get engaged in something, you know, but then you really have to kind of cut yourself off from the rest of society to keep the risk low. So, you know, those aren't really fun scenarios either. But is the reopening that we're seeing, and I know it's very different state by state, is that appropriate in review now, or is this premature? I think it's appropriate to be thinking about it in some places to take baby steps. You know, I'd like to see, first of all, you want good testing capacity. You need to have the capacity to spot surges pretty quickly. So that's what you get with testing. You need the capacity to manage surges well, which means you need enough PPE, the personal protective equipment for healthcare workers and beds and ICU beds and ventilators. And then you also need the capacity to shut down

the chains of transmission without having to tell everyone to go back home. And that's where people talk about contact tracing, isolation, and quarantine. Those are really the building mission without having to, you know, tell everyone to go back home. And that's where people talk about contact tracing, isolation, and quarantine. Those are really the building blocks of the response. That's what other countries have done successfully. And, you know, there's a path for us to follow there. The concern about opening too quickly, you know, there are places where the cases are still going up where they, you know, they're saying, go get a haircut, go get your nails done, is that now, you know, you have the capacity for exponential growth and you don't have those safeguards in place yet. And so, you know, they could really get into trouble, which would be

terrible. The flip side is if things are really going down, you're scaling up your response, you can start to take baby steps and people can feel confident, but you don't want people to feel like the danger has passed. And how do we evaluate that as citizens, right? Like I'm living here in California. I'm trying to read what the governor says. And the governor is at least saying things like, hey, the metrics are saying we can do this or that, or we're rolling out testing. But, you know, I'm not, the metrics are saying we can do this or that, or we're rolling out testing. But, you know, I'm not hey, I just started thinking about these things two months ago. Yeah, I'm not a I'm not a pandemic expert. It's hard for me to evaluate. And then, you know, again, everybody listening to this lives in a different state that has a different, you know, a different leader who's who's doing

this on a different basis. Sure. So I wrote a book called The Public Health Crisis Survival Guide. The course that I teach at the School of Public Health is called Crisis and Response in Public Health. And one of the most important principles of crisis response, particularly when there's a lot of uncertainty like there is now, is that communication to the public isn't just like telling people what you're doing. It is the thing you're doing. It is like part of the response. It's a core part of the response. And so what you're saying is, you know, how do I know what to believe?

You know, that's a really important question people have to ask. And the response, you know, core part of the response is being able to give information to you that you find credible. You know, in California, I've been impressed that the governor and commissioner of health, Dr. Angel, who I know well, are, you know, very, very driven by data and science. They're trying to do consistent briefings, you know, they're bringing in different experts to advise them. That's the right thing to do. And they should be communicating enough information for you to feel confident that if you do what they're recommending, that you'll be safe.

You know, the challenge we have is we're in this environment where you're hearing like 75 different things at once. You know, they're just one of the sources of information that you're getting. You have people saying, why can't we just, you know, be like Sweden? You have people saying, why can't we just, you know, be like Sweden? And then they will interpret what Sweden's doing or they'll say, you know, it's this is all it's all too soon. It's all too soon. We should all be, you know, quiet in our houses for the next year before we do anything. And, you know, it's you've got to sort of sort through that. But the best case scenario is where you have a political leader and a great health person who are able to, you know,

earn your confidence and then you can go with them. I think you're pretty lucky in California at the moment. Well, I do feel lucky, but I do have a broader concern about our public health infrastructure. You know, we had at the beginning of the pandemic, we had Dr. ashish jah on and he said uh you know what this is going to be is over the next couple of years us monitoring the outbreaks maybe having brief lockdowns hey everybody you know go self-quarantine for a little bit and you know coming back out making sure our testing is good you know really having a full societal eye on this and taking the appropriate response at all times. And I would say that looking at the actions of our leaders in America, state by state or nationally, I would say that to me, it seems uneven how science informed and public health informed the response has been and i'm a little bit uneasy

about our you know political infrastructure our our machinery of governance's ability to actually operate that way um you know i mean you see dr fauci up there and you say man this guy spent his lifetime studying this he knows what he's talking about and it sounds like people are listening to him but then the next day you maybe don't feel that way. And so I'm curious about your general sense of that. Well, I think you say that very well. It's been uneven would be charitable. You know, it's been it's been really quite a roller coaster of public health communication. I think there's been almost on the same day you'll have a reasonable message coming out and then the president himself will undercut it,

you know, contradict what his own public health experts are telling the country. And I mean, there's a whole science of this. Like in a crisis, if you give multiple messages to people, then they tune them out and they tend to think that they'll do something that's the easiest for them. That's really the conclusion. You know, the mask issue with where first, first we heard one thing about masks, then we heard another. And that is bad in this case. Right. Think about it. Like

if there were some news, you know, there's a hurricane or tornado or something and you're watching TV and you see that on one channel and they go like, stop what you're doing. Go to the basement right now. And you turn that and you're like, OK, maybe some people will run down to the basement. Right. But then you might turn the channel. And if the next channel they go like, there's no tornado coming. You don't need to go down to the basement. You know, then you turn the next channel and then go, well, you know, maybe there's a tornado coming, but maybe not. You know, most people won't go down to the basement. You know, most people will, you know, they'll do the thing that just seems like the most, you know, the most comfortable thing to be doing at that moment. And that's why when

you're asking people to really do something different, you really need people to be hearing a consistent, explained message. And so this has been really hard. So I taught my course on crisis and response from January to March. And when we started, it was like, oh, this is an interesting infection in China. I wonder what that could lead to. And by the end of the course, they dismissed, you know, we were doing it by Zoom. You know, the whole school had been closed. And you're supposed to be like, this is the best dollar I've ever spent on my education.

No class has been more worth the money than this one. Well, you know, I said to, you know, on our last class, we talked about at what point did you realize that the crisis was more important than the crisis class? Like, when did those lines cross for you that suddenly it was taking over your life? And we talked about what that realization was. As it was for me, we actually had a Washington Post reporter sit in on the last class and ask the students, you know, what did you learn? And they said, well, we learned that, like, all the things Dr. Sharfstein is telling us about the right way to run a crisis response are not happening in this country right now. And so, you know, it's been frustrating to see that there are ways to do communication better and crisis response better. And we haven't followed

that. There are some good examples out there. But, you know, I saw a public health person use the analogy of someone peeing in a swimming pool, you know, that like, it's great to say every state's on their own. But if one state is, you know, in the corner, they're doing its business not so well, you know, you're not so safe in the other part of the swimming pool, because people travel back and forth. So yeah, you know, it we are one country. And so that this kind of variation can be damaging if there's not good enough peer pressure and a good enough response from people and businesses to be careful. At the same time, it seems like the public has taken the message. The numbers I've seen for the number of people who support taking drastic measures like the lockdown, like or continuing the measures are very high, despite all of the ink that, you know, the sort of extreme, fringy, anti-vaccine protesters get.

When you look at like polling of people, they're they're very supportive of what are, you know, by any standard of our previous lives, very extreme measures. you know, by any standard of our previous lives, very extreme measures. Absolutely. And I think, you know, like on many things, there's a huge number of people who really have an intuitive sense of, you know, what's up and what's down, who can sort through different information and realize that this is a serious threat to themselves and their families. This is not a hoax at all. And that, you know, that this is an extraordinary time that requires extraordinary steps and not wishful thinking. The challenge in our political and sort of cultural moment, though, is that, you know, people gravitate to extremes when things get politicized. You know, it's really hard to

deal with. I mean, obviously, take climate change. You know, climate change is not really a political issue in the rest of the world. It is a political issue like crazy in the United States. And you have, you know, a whole group of people who are so focused on the politics that it's very hard for them to see the science. And as a result we've really um taken some steps back in this country i mean we're at risk of that happening on this issue yeah it happened stunningly quickly uh to at least for some people it became politicized um such that i mean i saw a tweet the other day i i forget which it was it was a state's public health department tweeted, do not drink bleach.

It is safe to drink bleach. And someone replied, wow, I thought this was a nonpartisan account. But I guess you're just getting into the politics. And that's that's bizarre. are um i've uh i've seen that myself that people would accuse a statement of don't drink bleach as being political um is is unfortunate yeah it's really amazing because there were people out there drinking bleach you know and poison control calls went up and you know and and the virus doesn't pay attention, you know, to Twitter, to the, you know, the politics of the moment, to what the president's approval ratings are. I did a early interview. It was when we weren't doing things on Zoom.

It was right as things were happening. I think it might have been on PBS. And I said something like that. And people, you know, I got comments like, you know, I don't know what you meant by that, Josh. But like, you know, the virus is just looking to spread. That's what viruses are doing. Viruses want people to get together so they can jump from person to person. Viruses are this biological drive to reproduce.

And the politics does not matter to the virus. And so we're just creating obstacles for our ability to save lives when we throw up those kinds of nonsense. Well, I want to talk about who is being harmed by this. I've seen some stunning statistics. And again, sorry to keep bringing it back to California. It's where I live, and so I tend to see those statistics a little bit more. So I apologize for those listening who might find this a little California-centric,

but here I've seen numbers like nearly half of infections are in institutional settings, like nursing homes, prisons, homeless shelters, places like that. And I'm going to butcher it, but, and I forget, I forget if this is in LA County or in California,

but it was something like 38% of deaths were in nursing homes of the ones that we've had so far, which is really stunning to me. And I want to know if you could speak to that a little bit. Why is that? Sure. Well, we're learning a lot about the virus itself and the susceptibility for serious infection. And it's clear that people living in close quarters with each other are at very high risk for passing it on person to person. And so you combine that with the very, very strong risk factor that ages or previous, you know, serious chronic illness and, you know, the nursing homes are incredibly at risk. And then you combine that

with the fact that you have a lot of people who work in more than one nursing home that, you know, in general, they have had lapses in infection control. And you combine that with the fact that there's pre-symptomatic spread so that people can be working and not realizing that they're passing it on. And it's just been a huge disaster. And people are asking, can this approach to nursing homes even survive this kind of horrible infectious disease because there's just such a serious risk. I don't think we figured out how to really stop it. I mean, obviously, if you treat it like a hospital, you throw in a huge amount of PPE, everybody's sort of in their own room, there's no congregate anything, no meals, then it looks like you can shut things down, which is absolutely

necessary now to save lives. But that's not why people, you know, go to these settings. They go to these settings for more of a social life. And so it's just been terrifying, I think, for a lot of people. They can't see their families. So it's very, very serious there. It's very important that they have access to testing, PPE, and a quick response when there are outbreaks. And that may require a lot more staff. It may mean that, you know, right now there's this weird dilemma, which is if you start testing everyone and you find half your staff has it and they have to go home, you've got nobody to take care of the people.

And so we have to be able to shore up the nursing homes with alternative staff, which is something that Maryland, my state, has been starting to do now because it's such a risk. And then you go to prisons and jails, and obviously they weren't designed for a pandemic, and there's just enormous risk, not just to the prisoners, people who are detained, but to the staff there, many of whom may be older and at risk for death. And, you know, shelters as well, where people have chronic illness. So, I mean, like I said, this is kind of exploiting different aspects of our society. You know, other societies where you don't have that much congregate living among the older adults don't have this problem or they don't have such serious homeless challenges, they're spared there too. So it's sort of picking apart

some of the weaknesses that we have and finding where people are in close touch. And I think, you know, we should also talk for a second about the really startling statistics in some areas about racial and ethnic minorities. Yeah. And before we get to that, though, I just want to stay on these institutional settings, because, I mean, do you find it worrisome or upsetting that, I mean, these are all the places you just listed. These are where we, as a society, keep people that we don't want to think about, you know, nursing home. I mean, obviously, people whose parents are in a nursing home. I'm not I'm not, you know, being judgmental of that. But, you know, that is certainly a form of American life that the average American doesn't think about that often. Right. And that goes doubly, triply for prisons, jails, uh, homeless shelters, uh, and, you

know, mental health facilities, uh, places like that. Um, and I don't know, I have this fear that if that's, what's going to be hardest hit, if that is the true impact of the pandemic, um, and you know, us not taking the steps we need to is going to harm those folks the most. Well, those are the same folks who are the most helpless, right? The most dependent on everybody else and who everybody else will notice the least what happens in those places. You know, like you can read a news article. Oh, my God, things are bad in nursing homes right now. But it doesn't affect you walking down the street in the same way that it does,

you know, when your workplace is closed. And so there's like an asymmetry in, you know, the actions that I as the, you know, individual American take versus the people who are impacted. Does that concern you at all? Well, I think that that's one reason why it's been so hard to have better policies in those areas for a long time. You know, hard to have better policies in those areas for a long time. You know, and it may be one reason why it's hard for us to really do what's necessary to protect them now. I do think that there is a real connection, though, because if people in nursing homes get so sick that the hospitals fill up, then, you know, that creates a huge problem for everyone else's ability to go to the hospital. So, we are connected, you know, for a long time,

people in, you know, my field and others have said, you know, we're kind of all connected. There's one, you know, public health system, there's one world that we live in. And, you know, if kids are going hungry, that is not good for us directly, because then they, you know, they don't realize their potential. They, that hurts our economy's ability. It hurts our social, you know, system in many different ways. And we should all care about the people who are enduring these situations because we're all connected. And I think people really never in this country that that has not been the prevailing way of thinking about it.

To a certain extent, it's been more about charity. Like if you're helping someone less fortunate, that's charity. It's not kind of because we're all part of the same system. But, you know, if there ever were an argument for we're part of the same system, it's a pandemic. And, you know, I would also just draw your attention to Singapore. So Singapore did a phenomenal job controlling this virus. And then it popped up again among immigrants in Singapore. And it's just been, you know, thousands and thousands of cases.

And it turns out they have dormitories for immigrants with like 15 people in a room by reports. And, you know, so it picked the part of the Singapore society that probably I'm guessing was the part that people didn't, you know, who are regular Singapore citizens didn't think about that much, you know, in the same way. But, you know, now their school's canceled. Everybody's at home. You know, it's just it's one system and they have to respond to it. And this is really for us to be successful and save everyone's lives. We have to respond to these areas And this is really, for us to be successful and save everyone's lives, we have to

respond to these areas of really high need. So you said racial and ethnic disparities. I've seen really wild numbers about that as well. And yeah, why is that? Why are we seeing those disparities? So I heard a prominent epidemiologist, Dr. Sandro Galea from Boston University, talking about this. And, you know, he pointed out you have to separate out two things, greater chance of getting it and greater chance of dying if you have it. And so why would people have a greater chance of getting it? it. And Dr. Lisa Cooper, who's an expert in health equity at the School of Public Health and Medicine at Johns Hopkins, and nursing, I should say, with me. We've been talking about this a lot. And, you know, well, people who are in racial and ethnic minorities are less likely to have enough money to be able to isolate themselves successfully. You know, they may be living

with a lot of other people. So it's very hard to be completely on their own. They're definitely more likely to work low-wage jobs that require them to go to work, and certainly for quite a long time, and even now, without adequate protective equipment. So all those things increase the chance of getting infected in the first place. And then there are factors like chronic illness, particularly, that make people who have hypertension, diabetes, asthma, more likely to die if they get it. And those conditions are much more likely to be found in racial and ethnic minorities who also, not coincidentally, have less access to

healthcare. So, you know, people are coming to the attention of healthcare late, they may not be able to get tested. So it's really like a double whammy, more likely to get sick in the first place and more likely to get a severe course. And there are some things that can be done in the short term, but fundamentally these are reflecting an underlying problem in our society. Yeah, that's what, I forget where I saw this, but it's really stuck with me that what this is really doing is heightening and making more visible all of the inequities that already existed. heightening and making more visible like all of the inequities that already existed.

Like it's even when we're talking about we had John Abuya from the L.A. Times on talking about the trouble facing gig workers right now, that this is just an enhancement of a problem that was already there. Well, I have so many more questions for you about the virus itself and about a response to it, but we have to take a quick break. We'll be right back with more Josh Sharfstein. OK, we're back with Josh Sharfstein. Let's I have so many more questions for you. So let's get through them quickly. I saw a report in The L.A. Times that there is a mutated strain of coronavirus that has sort of like take overtaken the original strain that that the the virus has changed in some way. I only saw it reported there, though. I didn't see it in many other news outlets.

I was wondering if you're familiar with what I'm talking about and how I should think about that. You know, I'm familiar with it, and I think only because I read a little bit about it. It seems like an intriguing idea. There are a lot of scientists who have said that it is a little premature to reach those conclusions, but that really understanding how the virus is mutating is important. In general, this is not a virus that

mutates as much as other viruses like HIV, for example, or influenza. And the prevailing wisdom going into this is that mutations would not be that significant in the short term. But, you know, with science, you have to test every single idea. And so I think understanding whether this is in fact true will be something that additional studies will clarify. So for you're speaking, so with such clarity about communication a moment ago, I read, you know, in the LA Times about this study, it was published on a non peer reviewed sort of preprint service, which I'm familiar is a way that, you know, reputable scientists do share their work. But I didn't know how reactive to that information to be. And, you know, I'm a little bit more scientifically literate than some people on Twitter, let's just say. So how do you advise when the science is so new, but it matters

to all of us so much. So we're all so much more concerned about every single study that comes out or every single possible, oh, this drug has been tested. That drug has been tested. How should we go about evaluating that information in our daily media diets? It's hard because there's so many studies and so many opinions about different studies and things start to sort of accumulate into a little bit more of a scientific understanding from an individual data point.

And then from there, it gets to the point of consensus. And the process, first of all, doesn't usually happen this fast. You know, it usually takes time and most people aren't paying attention to it. It doesn't happen under this kind of spotlight. So it's very, very challenging. And, you know, I'll go one study, they'll go, kids don't pass on the virus.

And the next study, kids definitely pass on the virus. You know, both of those have a lot of implications for schools, which is a really important policy area. And kids are suffering a lot not being in school. And, you know, well, how risky is it to open schools again is a really active question. You know, this sort of, this uncertainty that you're talking about, it is sort of a theoretical question when it's like, is the virus mutating a little bit? What does that mean? But then there are these questions like, well, how serious is it to reopen schools? You know, that is immediate impact. And so I'm looking at these studies and I have the same reaction that you do. Like,

this is on a preprint server. You know, what's the story? And sometimes I get myself worked up about a study. I'll call one of the experts in that field at the School of Public Health and they'll go, I read that preprint. And you've got to know that the way they actually found the cases was this way, so that conclusion doesn't make any sense. And I'll go, oh, okay, okay, okay. So I think it's just like a hazard of being aware now that we're going to be led in these different directions, and that it's okay. You need like a way of bringing in data that you kind of think through a little bit, you understand what it might be, and then you look to see whether there's other data like that, how people are thinking about it. And you

don't, you know, really invest yourself right away in any one little data point. And it seems like we need to have a cooling off period mentally. Like what you described, one study says one thing and another study says almost the exact opposite. That's how science works. That's a normal thing to happen. But normally, you know, a decade goes by and the wheat is separated from the chaff and a consensus emerges, right? And one of those studies, one of those results holds up, the other one doesn't. And this is a case where we sort of need to let that process play out as torturous as that may be. Like, I read that study and I almost tweeted it very quickly.

Oh, there's a new strain mutation. And then I was like, wait, wait, wait, I should see. I should see if this lasts. I should see if this is still true tomorrow before I do that. Yeah. And what people with different perspectives will say about it. I mean, it's, it's a situation, you know, in science, there are people who are really strongly held views and they'll put out their ideas as if they're, you know, for sure, correct. And then

there are these different correction processes that, you know, take place where people say, well, did you think about it this way? Did you think about it this way? Like, is this really the prevalence in Santa Clara County if you advertise this on Facebook? And, you know, is that going to catch people who are, you know, locked in their homes because they're terrified to go out? Probably not. So maybe this is an overcount, you know? So how, I don't know if you're familiar with that study. So like, you know, you see studies come out and then, you know, people raise issues about them. But over time, you know, this is a situation where even though there's a lot of uncertainty, we are actually slowly resolving the uncertainty. It's just hard to perceive because on any day it can be excruciating. be excruciating. But it's sort of like, you know, you're on a hike and you turn around, you see, we've come a pretty long way. I mean, we were in a period where in California, you know,

people were really worried about, you know, no room at the hospitals in the Bay Area, for example, or in LA. And that, you know, there could be so many deaths. And so we've learned a lot about what works about the virus. We've learned, you know, some medicines don't seem to have benefits. Some medicines might have a little bit of benefit. We've learned that there's serious pre-symptomatic spread, which really wasn't known at the beginning. You know, that's a really important finding. So even though we're in a period of uncertainty, the uncertainty that we're in won't last forever. It actually hasn't been lasting. It's just we just will get to new uncertainties. But we are clarifying things. And that process, you know, will continue. And the things that we'll learn will be increasingly important. Like science is on our side. The reason we're going through all this is to buy a little bit more time for science to clarify more things and eventually

get us to better treatments and vaccines. Well, let's talk about how we do that, how we buy that time. And back to public health, which is your specialty. You hear this argument, and I am sympathetic to it. It makes sense to me that, hey, there are costs of loss of life of this lockdown as well, right? That we need to balance those costs of, like you said, children not being in school, right? Say people who are living in poverty and aren't able to work and are losing money and then are not able to eat and then are passing away, right? Like that must be happening in some numbers. But it seems so difficult to quantify what that would be.

How do you go about thinking about that? Well, I think that we have to be thinking about opening. As much as we might want to say everybody stay in their house for two years, we can't do that. And even when we started, everybody needs food. People need emergency medical care. Like those needs don't go away. So we have to be thinking about that. We know that we can control the spread. We know from other countries that you can control it quite well. And so the path that public health officials have laid out is let's, you know, be serious about controlling the spread. When we get kind of start to capture it, let's build up the capacity to respond and then let's slowly but surely reopen.

You know, that the metaphor that I think works the best, I didn't come up with it, is we flipped off the lights, but now we're going to turn them on by a dimmer switch. And we're going to, you know, slowly make it brighter

and then a little bit less, but then people will have more and more confidence. And, you know, if we have a prolonged period without a lot of dust, people will start to make more investments in business and they'll appreciate, you know, the fact that, you know, new therapeutics are coming on the market and maybe there's a vaccine that shows like it might work. And that's how we develop our economic health again. The challenge is people have said, no, no, no, that's too slow. We got to go all the way up now, flip the lights back on, you know, or at least really turn the dimmer. And the challenge there is that if we

wind up with such a big out, you know, burst of illness that, you know, it really is going to terrify people and really undermine the economy. People, you know, it really is going to terrify people and really undermine the economy. People, you know, won't be going out if they are afraid of dying. And so, you know, that there, I think that our, the thinking is control the disease that gives economic confidence back, but, you know, don't wait forever, but, but get a good enough handle so that you can start to turn the lights back on with confidence. If you turn the lights back on and then it's just so dangerous, it's just going to be really hard. I mean, on a good day, consumer confidence is what drives the economy in the United States. And so, you know, that's before the pandemic. And now imagine,

you know, what it's like if people, you know, think that they might literally die if they go to a play or they go to a ball game or something like that. It's just not going to be that, you know, so I don't think it's so much of an either or, but people have lost, some people have lost patience for even a methodical way about it. And I think that that's really unfortunate. But you need to generate that confidence. You're right. Like, look, my field comedy, I'm very concerned with when people are going to feel comfortable going to a comedy club again. Like a comedy club is the perfect place to spread this. Everybody's, you know, you got waiters, you're touching drinks. People are laughing.

Ha ha. They're like spittles coming out of their mouths. Right. The comics are all putting their mouths right up on the microphone. It's very clearly a disgusting petri dish. up on the microphone um it's it's very clearly a disgusting petri dish and if we were to open everything up at once right now hey let's flick the lights back on i don't know who would go because i don't think that i i don't even know if i'd feel comfortable performing like if i was suddenly allowed to right you don't want to make an announcement like please do not laugh out loud

yeah yeah exactly and uh i mean i need people to laugh out loud for the show to work. But if we can slowly build people's confidence so that they like if we focus on that confident feeling, which will come from baby steps rather than trying to run all at once, maybe we have a better chance of getting back to that place sooner. I think so. And having a lot more happen in the meantime. And, you know, I do think that there's going to be this period of reinvention. I mean, if you think about medicine, medicine is suddenly, you know, discovering religion for telemedicine, which really had a hard time getting adopted in the United States. But now, you know, the doctors are afraid of getting sick. They don't want to expose themselves and their staff unnecessarily. And so if it can be done by

telemedicine, you know, do it by telemedicine. I mean, they're very, very brave medical staff are saying, you know, if you need my help, I'm there. But like, why take risk where you don't have to if you can do the same procedure or same, you know, exam over telemedicine. It's similar, you know, comedy is one. And I've talked to so many different businesses at Johns Hopkins were, you know, asked to join calls for all these different industries. And they're really rethinking their models in some cases.

And, you know, comedy is one that, you know, there may be different kinds of models that develop in the interim, you know? I mean, look, I can imagine comedy podcasts, you know, and things like that becoming, you know, where more of the industry goes. But like stand-up comedy does not exist without those people in that room, you know?

Like there are people trying to do Zoom shows and things like that. And it's just, you know, the art form is dependent on that space being full of people. And so, you know, there's certain things that don't translate that you have to do in person. We only have a few more minutes. I want to ask you about contact tracing. I've heard so much about I've seen plenty of articles saying we must have massive contact tracing.

I've seen descriptions of schemes where, you know, we could have our phones securely talk to each other and exchange a little bit of information, you know, securely without without revealing your who you are. But, you know, that sort of thing. I'm sure there's other schemes out there. It sounds like a huge amount of coordination, though. And I just wanted to know if you could speak to the importance of that and how likely it is that we're going to be able to do it on a scale we need to. the importance of that and how likely it is that we're going to be able to do it on the scale we need to? Sure. So contact tracing is extremely important because what you're doing is you're shutting off the spread of the virus from person to person. You find someone who's sick, you find who they may have given it to, and before they can give it to anyone else, you have them quarantine. Yeah. And therefore, during their infectious period, they're not giving it to anyone else. And so the virus can't find another place to go.

And eventually, the number of cases goes down. And that's what's worked in a whole bunch of countries. It's particularly challenging for this particular infection because of that pre-symptomatic spread, which means you have to move very fast from case to find the contacts. And you also have to be able to support the isolation and quarantine. You have to help people. If you tell someone to quarantine and they have no food at home, they're not going to quarantine.

So you have to get them food. You have to get them a hotel room if they can't stay at home. You have to figure something out so that they're not passing it to someone else. But it is a proven strategy. And so you have Governor Cuomo saying he may hire 10,000 or something contact tracers. Many parts of the country have started to do this pretty aggressively at the School of Public Health at Johns Hopkins. We're going to have a free online course with sort of basic information about contact tracing for the New York program and others available next week. And so it's promising. It is not like a

magic wand. You know, there are no magic wands yet. It's, you know, it's going to be very hard to find every single contact in time. But if you can find a lot of them, then you reduce the chance that the virus jumps from person to person. The most common contacts who get sicker in the household. So this is really a call for like talking to everyone in the household, could be, you know, roommates or whatever, making sure they stay home, getting people to really orient towards, you know, if you're exposed, it's 14 days. And here's a really important point. You get a negative test on day three, you still got to stay home for 14 days because you could be incubating the virus and getting sick two days later.

It's not really a question about testing. It's more a question about staying away, you know? And so I signed a letter with a bipartisan group of public health and health policy experts where we said, you know, Congress should allocate like $45 billion for a massive contact tracing and support effort because this is, you know, this is not just reducing the disease. This is allowing us to open without having to shut things down. If there's a problem, we can just manage this through contact tracing. And it's economic development to spend $46 billion, but it's economic development and public health together so that we can really rescue the economy. I mean, it's amazing we haven't made that investment yet, frankly.

Yeah, I really hope that we do. So last question for you. When you think about this, I've really come to accept that you see people tweet when this is all over, I'm going to yada yada. And I've come to realize there is no when this is all over. This is going to be years. This is a reality that we live in now and we hope to improve this reality. But there's no, hey, one day we're going to wake up and your old life is back. But I'm curious when you think about what life will be like a year from now, say, where do you think we'll be?

Where do you hope we'll be? What does that sort of long-term prospect look like to you? Sure. I mean, the real key question here is whether we're going to have a vaccine. That's the real long-term question. I mean, and with a vaccine, you know, you can wake up in the morning and not worry about it. I mean, smallpox used to terrify everybody on the planet. Hundreds of millions of people died in the 20th century, and it's gone completely because of vaccination.

Even measles, you know, is a horrible disease and cause all kinds of problems. If people get vaccinated, they're protected and they don't have to think about it every day. So I'm not as pessimistic that we'll be worried about this for years. If we can get a vaccine and that works for a good number of people, I think we will have a very, very good chance of moving past this. Now, how fast that can happen is another question. But I think, you know, there are scientific advances out there, even short of vaccines, that could make this a lot better. So I think of this as that we're using all the tools, the good sense, the communications,

the public health capacity that we have to buy as much time for scientists to help us. I mean, look at HIV and the amazing progress against the virus that was just a really, you know, difficult virus because of the way it affects the immune system. So, you know, I think about a year from now, you know, it's hard. It's hard. It's hazy, you know, as you think about the future. I would say that, It's hard. It's hazy, you know, as you think about the future. I would say that, you know, I'm very hopeful that we'll start to see some therapies such as the convalescent serum and antibody therapy that will really help particularly people in critical jobs on the front lines, protect them. And that will therefore protect people in nursing homes and other places. protect people in nursing homes and other places. I'm hopeful that there'll be some more kind of evidence about remdesivir or other antiviral drugs that will keep people from dying, which would be great. And that eventually, you know, we'll start to see efficacy of a vaccine. I'm personally not

counting on like fabulous results by the fall, like some people are out there talking about, it would obviously be great. But I'm hopeful that in a year, you know, we'll have resolved a lot of these questions, a lot better understanding of immunity. And that will allow for a lot more of our life to come back and some of it will be different. And some of those differences will be better, you know? Yeah. But I don't know whether we'll be completely out of this in a year. What do you think some of those differences will be? Because I think, say we do get the vaccine but I don't know whether we'll be completely out of this in a year. I wouldn't bet. What do you think some of those differences will be?

Because I think, say, say we do get the vaccine and everybody gets, gets the vaccine and okay. Coronavirus is a memory, right? But one thing we're going to be left with is this realization. This could happen again,

right? Like the, a, there could be another pandemic in our future, right? Well, I certainly think we'll, we'll behave differently

as a result? Well, that's a good last question here. I can tell you how I hope we behave differently. I hope we really invest in our public health infrastructure and not just the capacity to try to develop drugs and vaccines faster, but the structures that make us healthier on a daily basis that reduce those risk factors like chronic illness that end some of those disparities. We need to have a real serious reckoning that we have totally starved our collective capacity for health, for resources. And that, you know, no matter what's coming down a pike, if we fix that, we'll be in much better shape, no matter what's coming down the pike. And then, you know,

there's a faculty member at our school who talks about, you know, we have a national weather service that predicts when, you know, weather's coming. We should have a national infectious disease center, you know, that basically says what could be coming, what do we need, where are things? And so we're never taken this much by surprise again. And that this is professionalized.

It's not left to an administration to say it's a big deal or not a big deal. You know, you don't have people going out and going like, well, this is not a category five hurricane, even though the National Weather Service says it is, you know, that we really professionalize this and say that this is now part of our overall preparedness infrastructure. Thank you so much for being here, Josh. I really appreciate you coming on and talking to us about it. You've clarified a lot of issues for me. I really appreciate it. Well, thanks for everything that you're doing to bring good information to people. And thanks again for having me on your show a few years ago.

having me on your show a few years ago. Well, thank you once again to Josh Sharfstein for coming on the show. I hope you got as much out of the interview as I did. Please listen to his podcast, Public Health On Call, if you want to know more about coronavirus and public health and why it is so important. That is it for us this week on Factually. I want to thank our producer, Dana Wickens,

our engineers, Ryan Connor and Brett Morris, Sam Roudman, our superstar researcher who helps me with every single one of my monologues, helping me break down the facts and getting them in there for you. I want to thank Andrew WK

for our theme song. I don't even have to thank him because we paid for the theme song. You know, we licensed it. It's all above board, but I just love him so much. I wanted to give him a thank you. If you want to follow me

anywhere on social media, find me at Adam Conover. My website is adamconover.net. And we'll see you next week on Factually. Thanks so much for listening. Stay inside and keep those hands washed. That was a HateGum Podcast.