The New Yorker Radio Hour - Atul Gawande and Siddhartha Mukherjee on the State of the Pandemic

Episode Date: May 7, 2021

After a year of battling COVID-19, parts of the United States are celebrating a gradual turn toward normalcy, but the pandemic isn’t over—and it may never be over, exactly. Atul Gawande tells David Remnick that a hard core of vaccine resisters, along with reservoirs of the virus in domestic animals, may make herd immunity elusive. Rather, he says, the correct goal is to bring the impact of COVID-19 down to that of something like the flu. Meanwhile, India is now overwhelmed by a devastating death toll, reported at around four thousand per day but likely much higher. Siddhartha Mukherjee, who reported on the pandemic in developing nations, says that commitments from the West such as extra doses of the AstraZeneca vaccine will barely scratch the surface. A national mobilization will be required to even begin to flatten the curve. New Yorker Radio Hour listeners, we want to hear from you.  We have a few questions about the show and how you listen to it. The survey takes about twenty minutes, and your feedback will help us make our podcast better.  Take the survey here.

This is the New Yorker Radio Hour, a co-production of WNYC Studios and The New Yorker. I'm David Remnick, and this is the New Yorker Radio Hour. Last week, I called up Atul Gawande to talk about COVID in the United States and in India. My father comes from a village in the state of Maharashtra, which is the hardest hit state so far. And my mother's from Gujarat, where we also still have family. So I've been in regular contact getting WhatsApp updates. What are you hearing? Well, you know, it has totally flipped from the period when we were having 300,000 to 400,000 infections a day, and now it's the other way around. And it is running through

entire households like wildfire. I have elderly relatives who've ended up in the hospital and made it through. And then a cousin my age, who I never would have thought would have been hit so bad. And he died. And he died from this. I'm sorry to hear that. Yeah. And, and And I think, you know, and I'm nothing compared to what I know of other families and what they're going through. Atul Gawanda is a surgeon in Boston, and he runs a company called CIC Health, which provides COVID-19 testing and vaccines. He's also a longtime staff writer for the New Yorker and an expert on public health. The big difference from the United States experience is that you have such a fragile, and underfunded health care system.

And, you know, the hospitals just became overrun and overwhelmed, and it really has had this feeling of being on your own. That said, in Maharashtra, where the infection started, they have plateaued and the cases have started to come down as people locked down. And the core lesson is we do know how to stop this. We're going to come back to the situation in India, which is really dire, but I want to ask you first about the United States. For close to a year now, all we could think about was, when are we going to get a vaccine?

And now, at this point, more than 100 million Americans are vaccinated, and we're starting to see demand fall. In fact, plummet in some places. Some sites have closed for lack of interest, amazingly enough. So please, give me a sense of what this means for the vaccine rollout in the states. What's happening? I mean, what's happening here is mostly the upside of a successful acceleration of the rollout. We're working our way through the people who were desperately seeking vaccination, and we knew we would come to this point. The remaining people fall into three groups.

One is the group who would do it if you made it really easy. The second group are those who have a lot of questions and concerns want to, above all, talk to their physician about it, but are likely to be vaccinated if their concerns are addressed. And, you know, I'd put into that group, there's a good third of people who are afraid of needles out there. And then there is the 10 to 15% group that has not budged who are dead set against. And honestly, if we can get through those other populations, I think we will be, we will do fine. And yet we're hearing about the impossibility of herd immunity because of the vaccine resistance. I'm skeptical that we can get to herd immunity for a number of reasons. Number one is, you know, what is the right number of people to get vaccinated in order for the epidemic to collapse?

maybe it's 90% with the new variants, and that may be a reason why we don't get to herd immunity. Another reason is that we know that there are animal reservoirs, including pets, including other animals in our environment, that can keep the virus circulating potentially. And then, yes, you know, if 30% of the country never gets vaccinated, it's very unlikely, we will knock it out completely. But in my mind, the target has been, can we get this to be less than the flu? You know, the flu is just north of 100 deaths a day in a typical year. And if we can get COVID-19 down to 100 deaths a day or fewer, we're in an entirely different world.

We are not near that. We're still, you know, 600 to 700 deaths a day. And we have a ways to go. Let's talk about persuasion, the campaign for persuading vaccine hesitant people to get a vaccine. It amazes me a tool that when I turn on either social, look at social media or I turn on television or whatever it is, I'm not seeing countless celebrities of different kinds appeal to everyone in this country to get out. Yeah. I don't see this.

I don't understand it. Well, there are a couple things. Number one, the celebrity appeals have proven not to work. What people believe are when they hear from their own health professionals, when they hear from their own community and the family members. And so, you know, what's interesting is you'd just be pouring hundreds of millions of dollars into ads that we're kind of turning people off more than turning people on. What does work is a combination of getting the vaccine into the hands of local,

providers getting the ground game going. And what we have had has been an incredible success with mass vaccination centers, come to stadiums, come to other sites. And that has to now shift. Our team, which has run vaccination at Gillette Stadium and with FEMA, has shifted now to almost 20 different sites. We're about to have approval for 12 to 15-year-olds. I want to see us offering in every high school around the country, vaccination to all the kids whose parents make it possible for them to do it. That's the thing that I want to see much more of, less the ads, and much more that in every community you are hearing that this is moving now out of the stadiums and into these pop-up capabilities. So vaccine trials are now underway for kids. How will the equation around herd immunity change, if at all, once we start vaccinating children?

It's going to be, it's a difficult equation for kids because although kids are also dying from this disease, you know, we have a children's hospital here with ICU beds full of kids who have serious complex inflammatory syndromes, having people understand the parents and the kids that this is for their benefit getting vaccinated, that it is to their good and these vaccines have only rare serious side effects. That's going to take significant persuasion. And it's not much of a cell, especially to parents, that we want our kids vaccinated in order to protect the entire community. That is quite disturbing to hear. that it's not a very good cell to appeal to community.

Up and down in the United States, it has not been a successful cell to say, roll up your arm for the sake of your community, for the sake of the country. I don't mean to linger over this point, but this is a country that prides itself or has historically, I will sign up for the army and risk my life for the sake of protecting this country, its values,

but not to take a needle shot in the arms so that others, as well as yourself, might not die? That seems terrible. I think there is pride in people who've taken the shot that they have done something to help others as well. But when you're talking about the reluctant community who have not yet stepped up to get the vaccination, all the surveys, all the focus groups indicate that that is not the persuasive argument. Now, I know you helped advise the Biden administration during the transition on this crisis. How would you grade how the Biden administration has helped or not helped the effort in India? Well, a week ago, I would have and was giving it very poor scores because there have been weeks of discussion about the fact that we have bought tens of millions of doses of AstraZeneca vaccine.

which has not even gone through the approval process here, will expire at some point and can be given to the rest of the world when we clearly have supplies, more than sufficient supplies. As you said, our supplies are already exceeding demand in the United States. Now, what you see is a remarkable undertaking, which is not only the release of the doses of AstraZeneca vaccine, but then also a commitment of enough dollars to support the manufacturing of a billion more vaccines in India. The support is starting to get there, and it's the U.S. and it's many other parts of the world. Should President Biden pressure Pfizer-Moderna to lift the IP strictures, if not give it away, then lower the prices vastly to help places like India,

Brazil, Nigeria? Yes. What I would say is that there's much more complexity to it than that, unfortunately. The complexity is, first of all, India is the vaccine supplier to the world, and they're, unsurprisingly, needing to focus on delivering their vaccine locally. we have to generate much more supply of vaccine around the world. And building that supply is going to be a lot more than just saying release the IP. What we really need are the companies to support building factories in every major region of the world. And I agree with those who say it just seems morally unconscionable for us to have hoarded and controlled supply.

while the rest of the world is being told that they may not receive enough supply until 2022. That's Atul Gawande, who's a surgeon at Brigham and Women's Hospital in Boston, and the author of Being Mortal and other books, will continue in a moment. You know, someone said statistics are just numbers with the tears washed away. This is the moment in which we see that statistics as numbers with tears washed away. Siddhartha Mukherjee wrote recently for The New Yorker about how the pandemic was hitting countries all over the world quite differently, with particular attention to India where he grew up. India is now reporting nearly 4,000 deaths a day from COVID.

But experts think that the real toll may be many times higher than that. And the promises made by the Biden administration, Mukherjee says they're not going to suddenly save the day. For a country of 1.3 billion people, 60 million doses, as you can imagine, is three zeros away or two zeros away. And so it is a nominal gesture, but of course an important gesture. India right now needs locally made vaccines. Now, we still do not know the extent to which, these vaccines can or cannot counter the variants that are prevalent in India, the 1617 and the 117 strain that are predominant in India.

So to be clear, we don't know how good or bad they are, and there's not enough of it. And from abroad, what's being donated, what's been given is a drop in the ocean. Overall, said what you're suggesting is extremely dark, which is to say that the capacity for India to turn this around in reasonably rapid fashion is dire. Well, so it depends on what GARC means to you. So let me organize the priorities. The priority number one is to get oxygen to sites where they need oxygen. You and I and others sitting outside India can't really help because this is a federal

Indian priority using trains, using potentially the army. The second priority is setting up field hospitals and potentially using the army to create these field hospitals where people really need help. And the third is, of course, vaccines and vaccinations. If those are done really quickly, I think we can decompress. by 50 to 75% the situation in the hospitals in India. But unless all these three pillars work in coordination, I just don't see a way ahead.

Is it dark? Yes, it's dark. I mean, the fire is burning in crematoria every day. My friend's father died two days ago. But on the other hand, I think, It's a kind of all hands-on-deck situation. And is the crisis centered in the cities? The crisis is largely centered in the cities and in urban slums.

But of course, it's leaking everywhere. It's leaking into villages, leaking into everywhere else. But at least in these cities, the presence of field hospitals would be very helpful. They have been set up before. India knows how to do them. And so the crisis can be handled. at least in the prima facie level at that way. Sid, we are more than a year into this pandemic.

And I have to say that among my first thoughts a year ago was this is going to especially affect a place like India, particularly in its cities, which are so dense and in so many instances poor. And the infrastructure is what you describe. And yet that's not what we were hearing for quite a while. while. Was that just a matter of American self-obsession, or was there truly a lag, a delay before the worst hit India? And why? I think there was a lag and a delay before it hit India, and there are

several reasons. One is that the Indian population is younger. So the average median age in India is 28 years, as opposed to 40 odd years in the United States and Italy and Spain and other places. So there was that fact. There was also the idea that India encountered the so-called old strain of COVID, the original strain of COVID. And it seemed to sort of manage that old strain with 150-odd thousand deaths, which, of course, per capita, given the population of India, is vastly less than that. the United States or even Belgium or other places.

And so there was a brief moment of reprieve in which we in India sensed that the worst had been over. I think a vast degree of political complacency and a lack of preparedness, some degree, which we still don't know yet, of a new strain arriving. and some degree of the collapse of public infrastructure. And really, this is a warning to other countries and other countries to prepare for a second wave and a third wave and a fourth wave of the pandemic. Don't think of this as a local problem, but as a global problem.

1617 and 117 are already in the United States. It's not as if we're protected. Vaccine hesitancy in this situation is a disaster. Because if it turns out that Pfizer and Moderna vaccines, even though they produce enough antibodies, are not sufficient to protect you against these new strains that are emerging, understand that this is going to come to America before you know it. Sid, I really appreciate it.

My pleasure. Sid Arthur Mukherjee is an oncologist at New York, Hospital, Columbia Medical Center. His books include The Gene. And I spoke earlier with staff writer, Atul Gawande, who's a surgeon at Brigham and Women's Hospital in Boston, and the author of Being Mortal and other books. After I spoke with Sid and Atul, the Biden administration came out in support of releasing IP protections for the major COVID vaccines. Now the question goes to negotiators at the World Trade Organization. I'm David Remnick, and that's our program for today. I want to thank you for listening. Hope you can join us next time.

The Yorker Radio Hour is a co-production of WNYC Studios and The New Yorker. Our theme music was composed and performed by Merrill Garbus of Tune Arts, with additional music by Alexis Quadrado. This episode was produced by Alex Barron, Emily Boutin, Have Carrillo, Riannon-N-Corbi, Calliia, David Krasnow, Gauphin and Putugueuele, Louis Mitchell, Michelle Moses, Annabelle, and Stephen Valentino, with help from Alison McAdam, Meng Faye Chen, and Emily Mann. And we had additional help from Harrison Keith Lyme. The New Yorker Radio Hour is supported in part by the Cherina Endowment Fund.