Is The Coronavirus Peak Yet To Come? Our Q+A With A Former Obama Health Official
Andy Slavitt speaks to the success of social distancing measures, what we can expect, and why it’s important to try to find some humor in bleak times.
One of the leading public health voices to emerge during the coronavirus crisis is Andy Slavitt, the former acting Administrator of the Centers for Medicare and Medicaid Services under President Obama, who went on to found a non-profit called United States of Care. His rapid-fire daily tweets involve taking a huge amount of real-time data and synthesizing it into language that everyone can understand — with an emphasis on staying home, social distancing, and flattening the curve. He’s launched a podcast, “In the Bubble,” where he speaks to guests both inside and outside of the medical field in order to keep people up to speed.
Slavitt sat down for a Skype interview with NowThis recently to talk about the success of social distancing measures, what we can expect in the U.S. over the next couple of months, and why it’s important to try to find some humor in bleak times. Read our Q&A with Slavitt below, which has been edited for length and clarity.
VERSHA: Given your career, have you ever encountered anything like this before? I think, rightly so, we're saying this is a scale that many of us have not seen in our lifetimes.
ANDY SLAVITT: Well, I think two things. First of all, I don't think anybody alive, unless they were alive during the 1918 flu, has seen anything like this — or unless they were in Africa during the Ebola crisis. This is a larger scale, but also from a traumatic standpoint, because it feels so uncertain to people. It feels like people felt after 9/11, except even more uncertain than that. I would say there's another element of this. I'm 53 (even though I’m sure I look 25), but I've never been asked to sacrifice in any significant way. My generation hasn't, younger generations haven't, even slightly older generations haven't, like people did during World War II and in other times in our history.
That feels foreign to us, too. We're used to basically getting what we want when we want it. We're used to lots and lots of options. We're not used to the shelves being out of stuff. We're not used to not being able to go out, aren't used to being able to not see our friends and all that. It feels like a tremendous burden. I'm feeling if we told people during earlier times that our sacrifice was to stay home with our family, they would say, this is not quite such a big sacrifice. Now, I don't mean to minimize it. Because the loss of income, the insecurity, the sense of lack of context, the anxiety, the inability to be comforted by the people in your life that you love...the fact that you can't watch your sports team or your entertainment show...all of those things, I'm not discounting any. They're hard. But also in hard times, great things can happen. And the support that we can give one another is even more important.
VERSHA: From what you’ve seen so far, is social distancing working the way that we want it to?
A: Absolutely. No question.
I have access to data which is real-time. We did a comparison of two counties, Santa Clara, California and the other one was Miami-Dade County. Santa Clara, which put in place very intensive restrictions, closed bars and restaurants early; [and] Miami Dade, which didn't. We graphed what happened after each action. And there were dramatic reductions in fevers, which are an early warning [for COVID-19]. We looked at fevers compared to normal, what they would normally be at this time of year. Now that's great news. It shows that these things work.
VERSHA: We get a lot of questions from people who just want clarification about self-quarantining, for that 14-day period specifically. If a person does that for 14 days and they're not showing any symptoms, does that mean they're free to roam around, but still stay 6 feet away from people? What happens at the end of that 14 days?
A: Yeah, you should start licking surfaces and getting real close to people (laughs). No, if you go through 14 days, [and] you haven't had a test so you don't know if you've had it, you don't know if you had immunity, you still need to be careful, but you don't need to isolate.
The people I'm most concerned about are people who are living in close quarters, multigenerational households. If you live with a parent or a grandparent, you've got to be extremely careful and cautious, [along with] people who are living in nursing homes, people living in low income communities. So think about who you come in contact with. Recognize that even if you're past those 14 days, particularly if you're younger, you're highly likely to be asymptomatic if you have it. So I wouldn't let my guard all the way down. I would keep track of who I was in contact with. I wouldn't go spend a lot of time with your grandparents or so forth, yet. But yes, you can get yourself out of your room and you can go for a jog.
VERSHA: Great. And if people are feeling sick, then they should still stay home, right? The first thing that they need to do is call their doctor or maybe even video chat their doctor — but they don't need to go in as the first step.
A: That's right. There's a great new web portal out called “While At Home” that DeRay Mckesson put together. There's access to a free telemedicine video visit if you don't have that access yourself. I think if you’re just feeling a little feverish, and not so bad, and you think you might have it, just assume you have it. It'll be like a viral flu. You'll go through it and it won't be pleasant, but it won't necessarily be terrible. I know a number of people who have been through it. If you're having trouble breathing, then you want to go to the hospital. But you really don't want to be in the ER or any place around a lot of people who potentially have it unless you absolutely need to be.
VERSHA: Bill Gates said that he doesn't think the kind of state-by-state, ad hoc shutdowns are working and that we need a national shutdown. What do you think of that?
A: I think Bill Gates is way smarter than me, so far be it for me to disagree with him. The only thing I would say is it doesn't work when it's politically driven … this is going to go through different parts of the country in waves, at different times. So if I were the federal government, I would put a strict set of rules in place for when it makes sense to do what. In Cleveland right now, many of their hospitals are a third full, and in New York, they're overflowing. Cleveland will get there and New York will hopefully get past its peak. And so it will make all the sense in the world to share equipment, machinery, clinicians back and forth between these cities.
VERSHA: That's something Gov. Cuomo has brought up in press conferences, which is that New York is expected to hit this so-called ‘apex’ first. And his suggestion is, help us now, and when the apex comes to your state, we will help you and give you that equipment back. So you feel like it's going to be this rolling basis in the U.S.?
A: Yeah, southern Italy isn't in nearly the situation that northern Italy is. I mean it's there, but you know, there's people in Southern Italy that are like: why'd you close my trattoria when things are fine here? I think part of [Bill Gates’] point is because it’s spreading via community, and we don't have good enough surveillance, we don't have enough testing, you have to be conservative. You can't wait. You have to go [shut down] earlier than you think. It's like fighting a war. We can do a lot with logistics. We just launched a website today called Project N95/Vents, and in concert with FEMA, we are moving vents all around the country to where they need to be. Hopefully people will cooperate and support.
VERSHA: So you're working with various private organizations and with FEMA to make that happen?
A: Yes. We’ve stood up Project N95 Masks. We're working on testing. We've put out a five-point policy plan for the federal government. We sent a set of recommendations with guidelines [for] states. ...There are different people who are volunteering and have good ideas and I'm trying to help enable them because that's how we're going to get through this. It feels a lot better to contribute than feel helpless right now. Going through stuff like this, it’s hard. But if you feel like you're doing something, it feels good. You get through it, it's a good way to cope with it. And then, you know, when we look back on this — and the vast, vast, vast majority of us are going to be looking back on this at some point — we're going to ask ourselves, what were we doing? What did we do during this time? Did we help? If it's as much as bringing a bowl of soup to an elderly neighbor to anything else, this is a great time to build a community and show compassion.
VERSHA: I want to dig into the numbers that you mentioned a little bit earlier about the South. I think you said cases are growing faster in Louisiana than anywhere in the world — how did that happen? I understand people think Mardi Gras was part of it, unfortunately. I think it’s over a million people [who] come to New Orleans during Mardi Gras, and that was in February. What is the data showing us about Louisiana?
A: Louisiana is a bad combination of factors. You start with Mardi Gras, which I think is probably the original sin. Then on top of that, you have a lot of low income people, a lot of multigenerational households. … New Orleans is the biggest hotspot in the world right now [as of late March/early April]. It's the fastest growing place for coronavirus in the world. It's growing at 67% a day. ... I so worry for New Orleans, and they've been through crises before. So I think all of those factors — and if you start late, I mean, the people who made the tough decisions early, started closing stuff down, are the ones that are in the best shape. [California Gov.] Gavin Newsom, I think, probably saved an untold number of lives by acting quickly. And I think people felt at the time “wow, this is extreme.” But I think history will show that it was quite prudent.
VERSHA: I'm a little worried about the surrounding states also around Louisiana. I know the Mississippi governor seems to be one who is not taking this seriously, so what is your advice to people living in those states who might be watching right now?
A: A, don’t elect an idiot. [laughs]
VERSHA: Keep this in mind the next election, yes.
A: I have no idea how or why this became partisan, these sorts of decisions. It’s like certain people feel like the Democrats are just out to get Trump and spoil his economy. And I do have a certain amount of empathy. There's no right answers here. There's no winning. Every decision you make, whether you hurt the economy, hurt people's lives, you hurt people's health — it's not easy. But listen to the scientists. I don't know the governor of Mississippi, but I feel like part of this is paying the price for kind of living in an anti-science, anti-expert kind of a moment in our history … people down there are going to pay the price for that more than they need to.
VERSHA: In New York, Cuomo has said we've obviously ramped up testing — as it should be — but the point that he's making is: testing is not showing us the actual number of cases. It's just showing us that we're doing more testing, and people are kind of conflating the two. What should people keep in mind about the stats they're looking at?
A: Keep in mind that even though we're leading the world now in reported cases, the vast majority of our cases are unreported.
VERSHA: Right, so that number is even higher.
A: Much higher. Many more people are infected. We ramped up testing from about 10,000 tests a week to about 200,000 tests a week. So I'm seeing in the numbers some catch-up, as opposed to just new infections.
So I think the #StayHome movement is working better than we know. Of course there's a lag to hospital visits and deaths. What we're seeing now when we look at people hospitalized and we look at deaths are the things that happened a month ago, when we were kind of more asleep at the wheel. So if we are on our game now, we'll start to see those numbers decline. ...I think the more you get it, the more I think you see how effective it is to stay home and the more people will comply with that.
VERSHA: Because there are so many asymptomatic carriers and we're still catching up testing-wise, is it possible that we're just never going to know how many Americans actually had the virus from December to March?
A: Yeah. I think there's some really interesting debates going on among scientists, that some people believe we've had a lot more exposure [to COVID-19] with a lot more mild cases. And some people believe maybe a little bit of that, but not a ton. The way we'll learn is when we develop these antibody tests, which are already starting to roll out, which will test whether or not we're immune — which will be necessary for all of us to begin to take, and get back. And a bunch of us will find: “Hey, we were infected. We developed this antibody.”
VERSHA: There was a New York Times piece about some experimental tests going on with blood plasma. Could you explain that to our audience?
A: So people who had it, either people who die from it or who are just sick with it, they're trying to see if by taking the blood plasma from those people and putting it into healthy people, [if] that creates an immunity.
VERSHA: Okay, so that’s about finding possible natural immunity to it.
A: Scientists are going to be doing some amazing things if we just give them a chance. If we just slow this thing down enough, scientists will help us catch up, with antivirals, with prophylactics, with a vaccine of course, with new ways of thinking about it, new antiviral drugs. We've talked about a lot of the things that we kind of screwed up, but there's some things we're great at and there's things that are going to get us out of this. If we give people a chance, we can do that.
VERSHA: The talk was that a vaccine could be developed within the next 18 months. Do you feel like that's still a realistic timeline?
A: Yeah, people ask, can it be rushed? Some of it can be rushed, but here's the thing: you don't want to develop a vaccine that you put in a couple hundred million people, and find out seven months later that you're killing people or making them worse. The people who are developing these vaccines, they know what they're doing. It's not that they need 18 months to figure it out. They need to observe people. And you’ve got to get the dosage right because you're giving it to older people, you're giving it to kids, you’re giving people way more or way less. You really want these things figured out. Then once you know that you've got a working vaccine — that could take about a year. You can then start to accelerate production. Producing a vaccine isn't like running a photocopier. There's just a lot of stuff that makes that not so quick and straightforward. But you’ve got to make it happen as quickly as humanly possible.
Science takes time. And remember, vaccines aren't perfect either. They're not going to be perfect for 100% of the population. There's an important case to be made that we're going to need to be careful with seniors and people who are at high risk on an ongoing basis. Even as [the virus] moderates, it's never going to completely disappear. There could be other strains of it. So we're going to need to learn to cope and live with it.
VERSHA: We thought the virus was on the decline in Singapore, in Taiwan, in parts of China, but we're seeing reports of more spikes happening again. How should we think about the waves that might come?
A: The waves will be caused by a couple of things. If you could take a city and lock it down, not let anybody in or out, and keep people at home for some period of time, you'd get rid of the virus. The problem is when someone flies in from another city or another country, it activates the process all over again. We live in a very connected world. So I think [places like] Singapore, Japan, Hong Kong, Wuhan, where they think they've got it beat, they learned that they really don't.
That means that you need really good testing and contact tracing. More and more of us will be immune. Those people who are immune, it'll be obviously safer for them and their ability to move and go and interact. But you can’t stop [others]. I mean...the people on spring break in Florida at the beach. We're only as good as our biggest idiot in some respects, right? Because there's always going to be that kid who was licking the stuff at the grocery store.
I think handshaking is done (laughs). I think 100 years from now people are going to be like, “Wait a minute. When you saw someone, you used to touch each other's hands? That’s weird. That’s so dangerous. Why would you do that?”
VERSHA: After touching our phones all day as well, which have so much bacteria on them. So we can't say, realistically, how long our lives are going to be like this. That's just something we have to kind of take week by week right now.
A: I think we're going to go through some phases. [Bill] Gates thinks that the phase we’re in, the social isolation phase, we need to keep up to 6-10 more weeks or so. Then if we do that well, we could be in a phase where if we've gotten better testing and contract tracing, we will be able open up — with careful monitoring, keeping distance, etc.
Hopefully, by that time, our health system will be prepared for people who are coming in. The third phase is when we have a vaccine and we'll begin to know that next year. And that will allow more people to develop herd immunity. Then the fourth phase is just what we talked about a little bit earlier. The “living with it.” It's going to happen seasonally, [and we’ll] have vaccines. Life will go on and then hopefully we'll be better prepared for the next pandemic. The question is not, to me, will we get through this? The question is how well will we get through this? How many people will we lose in the process? I don't view this as a mission, like to beat or defeat this thing. I view this as in every life saved. Everything we do that can help us save more lives, the history books will write this out better. … [There are] Great places for you to get involved and to help others and just keep yourself busy. What else do you have to do, right? (laughs)
VERSHA: I have to say, I'm impressed with the sense of humor that you've managed to retain through all of this. We've talked about how mental health is equally important right now. So as a final question, what are you doing to unwind? Is it a glass of wine at night? Is it binge watching some Netflix show?
A: A glass of red wine, [but] look, we shouldn't become alcoholics or drug abusers or anything out of this. It's a serious, serious point you're making, it's a really important point. The anxiety people feel is natural, and I think any therapist would tell you to acknowledge that anxiety and work through it. And understand everything you're going through, you're not going through it alone. You're going through it with others, we're all going through this together. Lean on people, have people lean on you, do not be in any way ashamed or embarrassed. The things that might give you joy in life, if that's a glass of red wine, if it's binge watching Netflix, whatever it is, do it. Do it. Enjoy. Get those moments of joy in. Shut off the fricking news every once in a while. That's why our podcast is not going to be beating you over the head, just like this conversation. Life, so many elements of our lives should go on, and even be richer. Like in my case, I've got my two sons home here with me. Sucks for them, but it’s great for me. They’re 21 and 18, there's every place in the world they'd rather be, but they're stuck with their mom and me. And so — I love that. Like, they hang out with me.
VERSHA: I think that’s important - people feeling that permission and not feeling guilty that they might be enjoying themselves during such a time. But we need that. We all need that.
A: Totally. Totally.
VERSHA: Any final words for our audience before we sign off?
A: First of all, if you're working in the healthcare field and you’re a frontline healthcare worker, you’re heroes. So much gratitude. I don't even know how to appreciate you. You're playing without a playbook. You're calling on reserves you didn’t know you had.
If you're not a frontline healthcare worker, thank every frontline healthcare worker you know. If you're staying in and sacrificing, I know it's hard, but thank you. You're actually saving lives. It's hard to imagine, but you're saving lives, which is pretty cool. We'll get through this, we'll get through this if we're there for each other. So thank you for having me on.
VERSHA: Thank you so much for joining us. I will take this opportunity to thank my sister who is a doctor in Louisiana, so thank you to Dr. Jaya McSharma.
A: Thank you to her.
Here are some resources Slavitt recommended: