--:-- Sean Rameswaram: Support for Today Explained comes from the FIFA World Cup, of all things. The FIFA World Cup 26 is coming to North America next summer. It is the ultimate celebration of sports and culture. You can get closer to the beautiful game with a hospitality package, closer to the action, the best seats, the best suites, closer to match day and that world-class food and that world-class entertainment, closer to the experience of a lifetime. Book a hospitality package at fifaworldcup.com slash hospitality. And listen to The Guardian for free at theguardian.com.
--:-- Sean Rameswaram: Even as coronavirus cases continue to climb, more than half of these United States have started to reopen. But it's not going smoothly. In states that are reopening, some mayors are defying their governors. Well, today, Missouri, the show-me state, is back in business as reopening begins. but a stay-at-home order continues in the state's biggest city. We want to responsibly reopen. We don't want to just flip the switch so that we see a rapid increase in cases.
--:-- Sean Rameswaram: In states that aren't reopening, some counties are doing it anyway. Will these now-opened businesses need to close? They're making a big mistake. They're putting their public at risk. They're putting our progress at risk. We've been clear about that. People are violating lockdowns. The beaches and bays are closed. with the surfboard, please return. Let's keep San Diego healthy, please return. Bunches of armed white people are protesting lockdowns. Hey, USA! Hey, USA! Hey! Hey, USA!
--:-- Sean Rameswaram: And then like, even when I go outside for a walk, I want to yell at people who jog past me, breathing all heavy on me without a mask. I mean, I'm finding myself holding back from yelling. Put on a... It feels like the country's going in two different directions at the same time. Half of us want to stay safe and sheltered, and the other half want to get out and get back to business. Either way, germs don't respect borders.
--:-- Sean Rameswaram: You know, that's like adding a peeing section in the public pool. But it didn't have to be this way. Today, the Associated Press reported that a document advising local governments on best practices for reopening was shelved by the Trump administration. The document was written by the Centers for Disease Control, an outfit we haven't heard much from during this pandemic, which is weird. This is kind of their thing.
--:-- Sean Rameswaram: It's been about two months since there's been a CDC press conference. Dr. Richard Besser used to run the CDC. When I led the agency during the swine flu pandemic in 2009, one of the most critical factors in terms of our success was communication and the ability to talk to the American public every single day and to have to answer tough questions from reporters who would say, well, why are you doing that? What are you thinking?
--:-- Sean Rameswaram: It pushed us to do better science. It pushed us to question our assumptions. without that transparency, without that ability to explain to the public why you're asking them to take certain steps, you get into trouble. And when the message is coming from a politician, half of the country is going to reject it out of hand because they don't support that politician.
--:-- Sean Rameswaram: What are we missing right now with the CDC out of public view? Reflecting back on my years at CDC, I was there for 13 years. We spent very little time focused on what it takes for people to adhere to the guidance we put forward. We spent a lot of time focused on what does the best science say? And the science says that if you have this infection, you should be isolated and people who had contact with you should be in quarantine.
--:-- Sean Rameswaram: Well, that should immediately beg the question of who's able to follow those instructions and who cannot and what kind of services need to be in place to ensure that everyone in America has a fair opportunity to follow that guidance. CDC just put up new guidance on what to do if you're sick, and they say to stay home, consult your doctor, don't take public transportation, and isolate in a room away from family members.
--:-- Sean Rameswaram: Well, if you think about each of those steps, it would be impossible for a frontline worker to do that who doesn't have health insurance, and that's 28 million people in America, someone who doesn't have a car. How are they going to get to their health care provider? And someone in a cramped apartment with extended family.
--:-- Sean Rameswaram: So each of those steps is not possible for millions of people. And overrepresented in that group for whom it's not possible are people of color, people of lower income. And we need to make sure that our guidance fits everyone in America if we truly want to decrease the burden And are those the people who are going to get hit the hardest as states continue to open up Do we know It very easy to predict who going to get hit the hardest
--:-- Sean Rameswaram: And it's the same groups that have been getting hit the hardest to date. Black Americans, Latinos, Native Americans are being hospitalized and are dying at rates of two, three, and more times their proportion of the population. There are many reasons for that. A very small percentage are able to work remotely. There are higher rates of underlying medical conditions.
--:-- Sean Rameswaram: So as economies open up, the workforce is going to expand and lower income workers who will be in the economy more will have more opportunity for exposure. And with that exposure, they'll have, unfortunately, a greater burden of disease. And I assume pulling off the Band-Aid and just reopening will be bad news for regular sick people too.
--:-- Sean Rameswaram: Just think about all of the health issues that people had in January before we even were thinking about coronavirus. Heart disease, cancer, diabetes, kidney disease. The flu. The flu. Yeah. All of these things that aren't being treated right now. I'm a general pediatrician and I'm thinking about all of the kids who aren't getting vaccinated, all of the parents who aren't coming in for well-child visits and getting the kind of guidance from their health care providers that they need
--:-- Sean Rameswaram: and pulling up the Band-Aid as saying, we are willing to sacrifice the lives of large numbers of people in order to get our economy back. And I don't think that we need to make that trade-off. And the trade-off that we're making would not be felt evenly across society. The burden would be put on lower income Americans, people of color, people who are in position to withstand this the least.
--:-- Sean Rameswaram: I think it's easy to look at some of the lockdown protests going on and judge the protesters as, you know, reckless or even worse. But when these lockdowns were announced, no one seemed to have a terribly good exit strategy. There were end dates, but those, you know, would inevitably change. it's easy to see why people are getting frustrated at this point.
--:-- Sean Rameswaram: Yeah. You know, in a time of great uncertainty, what people want the most is certainty. And you're right. That's something you can't give people. With effective communication, though, you can share what the critical questions are and what's being done to provide answers for those questions.
--:-- Sean Rameswaram: So, for instance, a critical question is, if you get this infection once, Will your body make protective factors, they're called antibodies, so that you can't get this infection again? I mean, that's a fundamental question that we don't know the answer to yet. Right. And the reason it's so important is you see states that are doing antibody testing across their population.
--:-- Sean Rameswaram: Unless you know what that information means, that people who have those antibodies are protected and can go back to work and don't have to worry, there's not a lot of value there. What do you think people like Dr. Fauci, the CDC, whoever it might be, state leaders, governors, should have said from the start to sort of better relate the uncertainty? Should the messaging have been different from the jump?
--:-- Sean Rameswaram: I think Dr. Fauci has done a good job of conveying that uncertainty. The one message that he put out, I think, two months ago that I use all the time is, You don't make the timeline. The virus makes the timeline. Just in that simple statement, it explains a lot. So when people say, well, when are we going to reopen schools? What's going to happen in the fall? What's going to happen when influenza comes? We don't know.
--:-- Sean Rameswaram: The virus hasn't given us its playbook. And so we're continually going to need to be studying and looking and adapting. And getting people into a level of comfort with uncertainty is one of the critical things that public health can do and is not being afforded the opportunity to do that. But now it looks like, you know, the administration is trying to turn the page.
--:-- Sean Rameswaram: The president said this week that he would disband his coronavirus task force. Then he walked that back. But he's certainly acting like we've accomplished something, even though cases are climbing. We're in early days of this pandemic. I heard one public health expert talk about us being in the second inning of a nine-inning game. Yeah.
--:-- Sean Rameswaram: Even there, it's hard to say. We don't know if there'll be extra innings, how many innings are going to be in this game. But we're clearly in early days. And so, you know, if the White House task force is going away, there's going to need to be some other body that replaces it that's able to make the critical policy decisions.
--:-- Sean Rameswaram: And I mean, a thing I just keep wondering is I think one thing all Americans, maybe people across the planet, have a sense of is how bad this got in New York City. By ripping off the Band-Aid and saying, let's just get this over with, are we putting cities across the country at risk of experiencing something like New York experienced?
--:-- Sean Rameswaram: I think we are. So pulling off that band-aid, we would see widespread transmission within communities. And just given the numbers, the sheer numbers of people who are susceptible, we would see our healthcare systems in many places overwhelmed like they were in New York City
--:-- Sean Rameswaram: How to reopen responsibly after the break. Support for Today Explained comes from Chime. Nobody likes fees and complicated banking, says Chime. And Chime gets that, says Chime. Chime is a financial technology company that says they understand that every dollar counts.
--:-- Sean Rameswaram: So when you set up direct deposit through Chime, they say you get access to fee-free features, such as free overdraft coverage, getting paid up to two days early with direct deposit, so much more. Chime says with qualifying direct deposits, you can be eligible for free overdraft up to $200 on debit card purchases and cash withdrawals.
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--:-- Sean Rameswaram: Dr. Bessie, you are on New Jersey's Recovery Commission. You're also a member of something called the Multi-State Council to Restore the Economy. What are you looking for when you're trying to help a state decide whether it's time to reopen?
--:-- Dr. Bessie: What we talk about with opening up the economy is a shift in our total approach to controlling this disease. You want to see a downward trend for at least two weeks in your hospitalizations. You want to make sure that there's excess hospital capacity so that there's room not just for taking care of patients who have COVID, but for all of those other conditions we were just talking about.
--:-- Sean Rameswaram: that you've got enough protective equipment, not just for hospitals, but for everybody who's going to be going back to work and those who are currently working. Widespread testing capacity is something that every state is talking about, that we need to be able to understand disease transmission, not just at a state level, but within regions.
--:-- Sean Rameswaram: Even New Jersey, which isn't a very large state, very different picture in the north, where it's near New York City to the south, where it's much more rural. We need to have a public health system in place that can do contact tracing, where you identify every person that the sick individual has had contact with.
--:-- Sean Rameswaram: And then you put those people into quarantine so that if they become sick, they're not further spreading the disease. No states have what it takes to do that. In New Jersey, we're talking several thousand workers who will be needed to do that. and then communicating, you know, explaining this, engaging people so that they understand what the shift is about.
--:-- Sean Rameswaram: that opening up the economy isn't saying, we're going back to the way it used to be. No, you're going to see things happening in a different way. As we look to open schools, they're not going to look the same. When you go to the beach, it's not going to be the way you went to the beach before.
--:-- Sean Rameswaram: When you go shopping at a store or at a mall, it's going to feel different. If you're going out for dinner, it's not going to be what you used to experience. How much do we know about where states are right now? Do we have enough data?
--:-- Dr. Bessie: We need to have data at a much more detailed level than we currently have. It's not just data in terms of hospitalizations and deaths. That data needs to be broken down by race, by ethnicity, by income, by disability.
--:-- Sean Rameswaram: And in addition to hospitalizations and deaths, you want to have data broken down by testing. And the reason that's really important is the World Health Organization suggests that the way you'll know that you have enough testing going on is if less than 10% of your tests are positive.
--:-- Sean Rameswaram: What that means is you're able to test far more people, people who may just have fever. This is particularly important in communities that are getting hit really, really hard. So if you're seeing in your state that overall testing is pretty good, but in certain communities, certain populations, the percent who are positive is very, very high, well, then it's telling you you need to target more testing there.
--:-- Sean Rameswaram: You need to look and see how are you providing testing. If you're providing data at that level, you'll be able to see changes much, much sooner before they result in an increase in deaths. How many states have made headway on these standards and guidelines that you looking at from the sort of downward trend in hospitalizations to testing and contact tracing I mean we got like half the country opening back up How many states are ready using the guidelines that you have?
--:-- Dr. Bessie: Well, I don't think that there are any that are ready to do it based on these principles. If CDC were out front and we're sharing information, we would be seeing dashboards. They would have their criteria and we would be able to see and you could check off which ones have in place these different pieces.
--:-- Sean Rameswaram: Yeah. Over the past 15 years or more, we have had a disinvestment in our public health system. Close to 60,000 public health workers lost at the local and state level. Well, when you're seeing a response here that requires such intensive activity from public health, it's going to take a while to build up that workforce.
--:-- Sean Rameswaram: So we need to have a national commitment to that. It would be a great jobs program. It would engage a lot of people who've been losing work. And it would help create this national spirit of, okay, here's what we're doing. We're in this together. Let's help ensure that everybody can do the right thing.
--:-- Sean Rameswaram: So we've got this crisis. We've got this economic crisis. There's an obvious solution that helps deal with both of them. And we're not doing it. I would be a little more generous than that because I do see many states laying out these principles and working towards them.
--:-- Sean Rameswaram: And one of the big challenges that states have is that most states have to balance their budget. So a state can lay out, here's what we need to do. We need to be able to test, track, isolate. And they can lay out what the budget is, but without major support from the federal government, states are not going to be able to deliver on that.
--:-- Sean Rameswaram: We just need to make sure that we are pushing so that there's the political will to get it done. I mean, that sounds good. But if we don't, if we don't get the standards, if we don't get the testing ramped up, if we don't get the contact tracing sort of effort that we need, what do we do then? Do we just relax standards and wait it out?
--:-- Sean Rameswaram: I don't think so. I think what we'll see is if states relax standards without these things in place, cases will go up, hospitalizations will go up, deaths will go up, and that will help shift the political equation. You don't want to see that as the driver here, but it's pretty hard to see how we wouldn't see healthcare systems overwhelmed if we open the economy too fast.
--:-- Sean Rameswaram: We don't know how long we're going to be in this. We don't know if we will ever have a vaccine to take care of this. And so we have to be moving forward slowly, carefully, allowing time for treatments to be developed. Hopefully, there will be additional effective treatments that will change the course for people who are infected.
--:-- Sean Rameswaram: But keeping it as a slow burn rather than an all-on shelter-in-place followed by massive spikes. That kind of slow trickle that we can handle is a much smarter approach that will save lives. I wonder, you say states can't do this on their own, that they need help from the federal government.
--:-- Sean Rameswaram: But then when I look at the federal government, we've got a president who has been trying to reopen since basically before states even closed. He told people to try injecting disinfectant. You used the word hopefully just now. Are you still hopeful?
--:-- Dr. Bessie: I am hopeful, you know, and I'm hopeful on a number of fronts. The biggest thing that gives me hope is that this pandemic has revealed major holes in our social safety net. It's revealed major gaps in terms of people's ability to even think about what we call the American dream.
--:-- Sean Rameswaram: And we will have the opportunity moving forward to rebuild our society in new ways and to ask the question, what kind of America do we want to have? Do we want to have a society in which everyone has that opportunity to succeed? Or do we want to continue to have a nation in which your income or the color of your skin are so predictive of your future?
--:-- Sean Rameswaram: Coming into this pandemic, your life expectancy could vary by decades just based on where you live. I'm in Princeton, New Jersey, and life expectancy for a child born here is 87 years. I volunteer in a pediatric clinic 15 miles away from here in Trent, New Jersey. That's our state capital.
--:-- Sean Rameswaram: Life expectancy for a child born there is 73 years. 15 miles and a 14-year difference in life expectancy. We have the opportunity going forward to say that's absolutely unacceptable, and we're going to put in place some of the policy solutions to undo those kinds of structural differences.
--:-- Sean Rameswaram: Dr. Richard Besser served as acting director of the Centers for Disease Control in the early days of the Obama administration. He's now the head of the Robert Wood Johnson Foundation. I'm Sean Ramos-Furham. This is Today Explained. Thank you.
