Assessing Public Health Risks

Assessing Public Health Risks

Rupak De Chowdhuri/Reuters
from State and Local Conference Calls and Webinars

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United States

Coronavirus

Public Health Threats and Pandemics

State and Local Governments

Dr. Leana Wen, visiting professor of public health at George Washington University, and former health commissioner for the city of Baltimore, discusses COVID-19, ​considerations for reopening, and best practices.

Learn more about CFR’s State and Local Officials Initiative.

Speaker

Leana Wen

Emergency Physician and Visiting Professor of Public Health, George Washington University; Former Health Commissioner for the City of Baltimore

Presider

Irina A. Faskianos

Vice President, National Program and Outreach, Council on Foreign Relations

FASKIANOS: Good afternoon to all of you. Welcome to the Council on Foreign Relations State and Local Officials Webinar. I’m Irina Faskianos, vice president for the National Program and Outreach here at CFR. As you know, CFR is an independent and nonpartisan organization, think tanks, and publisher, focusing on U.S. foreign policy. Through our State and Local Officials initiative we serve as a resource on international issues affecting the priorities and agendas of state and local governments by providing analysis on a wide range of policy topics. We also publish Foreign Affairs magazine. This is a challenging time for our country, so we thank you for being with us today. We have participants from forty-four states who will participate in this discussion, which is on the record.

We are pleased to have Dr. Leana Wen with us. We previously shared her full bio, so I’ll just give you a few highlights. Dr. Leana Wen is an emergency physician and visiting professor of health policy and management at the George Washington University’s Milken School of Public Health, where she is also distinguished fellow at the Fitzhugh Mullan Institute for Health Workforce Equity. She’s an expert in public health preparedness, and previously served as Baltimore’s health commissioner. Dr. Wen is a contributing columnist for the Washington Post and a frequent guest commentator on the COVID-19 crisis for CNN, MSNBC, and BBC. And in 2019, she was named one of modern health care’s top fifty physician executives, and Time Magazine’s 100 most influential people.

So, Dr. Wen, thank you very much for being with us. It would be great if you could begin with an update on where we are now with the COVID-19 pandemic in the United States, and how state and local officials should assess public health risks as we see the states beginning to reopen.

WEN: Thank you very much, Irina. And I want to thank you and CFR for hosting this briefing today, and also thank our local and state health officials and officials who are on this call. Actually, you know, as Irina mentioned, I served previously as the health commissioner for Baltimore, and think so much about how all of you are on the frontlines now in every way. And I have so much appreciation for what you do every single day. I had the opportunity to testify in front of the U.S. House of Representatives yesterday. The Select Subcommittee on the Coronavirus crisis held a briefing on COVID-19 and racial disparities, which turns out to be exactly the right time for us to be having this conversation about structural racism and how that goes into the disparities that we see and manifests itself in COVID-19.

But one of the things that I emphasized very strongly in that hearing is the importance of local flexibility and local funding, because it is all of you on the local level who understand best the needs of your communities and are the best positioned to address them, for COVID-19 and otherwise too. So I want to talk today about three topics based on the framing that Irina laid out. First I want to talk about where we were, what we’ve tried to do. Then I want to talk about my concerns about COVID-19 at this point. And then finally, as practical individuals, as state and local officials, I want to think about things that we can do right now.

So where we were and what we tried to do. You know, I put this in even though I know we’ve all been dealing with this, because I think there is still this misconception that again came up in this congressional hearing yesterday, this misconception that somehow we as public health experts want to close down the economy forever. (Laughs.) Right? I mean, this was actually directed as a question yesterday about how is it that public health experts want for everything to be shut down in perpetuity until we have vaccine? I have never heard any public health expert say that. And I think it’s important to talk about what we were trying to do.

What we’ve tried to do with social distancing was to say: Look, we have this virus that is extremely contagious, that is also very fatal. It’s not like the flu. It’s killing people at unprecedented numbers. It’s the greatest public health catastrophe of our lifetimes. And so we have to have social distancing to rein in the number of infections, to do the so-called flatten the curve, so that we could prevent the health-care system from being overwhelmed at once, but also to buy us time because ideally we could get to the point where the number of infections is steadily declining, and at the same time we are building up the public health capabilities. We are getting the testing, contact tracing, isolation, treatment capacities to be built up so that we can get the virus contained enough.

That’s what we did. And actually, in many ways we were successful. There was a Health Affairs study that found that if we had not put into place the social distancing/shelter in place orders, that we would have been more than ten times the number of infections as we currently do now. Now, the probably though is that unfortunately we did reopen, I think many would argue, too soon, in a sense that we did not use the time that we had to rebuild our capabilities the way that we should have. That we should have much more widespread testing than we do now. And unfortunately, we are reopening despite not having all these things in place. And what I have argued is that we are essentially in a new phase of this pandemic. We have decided to reopen anyway.

And as a result, we are in a phase that I call harm reduction, which is the idea—this is a concept we know well in public health—if you are going to be engaging in a behavior that has risk, at least we can try to reduce that risk as much as possible. And that means we should have guidelines in place to protect our workers, for people who are riding in public transportation. It’s not 100 percent safe, but there are things we can do to make it safer. And I think that’s the phase that we’re in now.

So my concerns—this is the second part that I want to talk about, my concerns. Of course, I am concerned that with reopenings occurring, also in the setting of these mass protests that are happening around our country, I am concerned that we’re going to see a surge in the number of cases. And I think the key at this point now is for us to make sure that we detect these cases, ideally a soon as they happen, because my concern—also as we’ve seen in nursing homes, in other congregant settings like jails and prisons—is that once you see one case there are actually many dozens, maybe hundreds of others that we’re just not picking up on.

Another concern I have is the misunderstanding that somehow reopening means that we are now safe. That’s not what this means. Reopening just means that we are reopening. The virus itself has not changed. We don’t have a vaccine. We don’t have a cure. And we still need to deal with the fact that we have a very contagious virus, and we all need to keep up our guard. I have another concern too that the CDC guidelines that came out unfortunately came out too late. And I don’t think that they’re as specific as they could be to be fully useful for all of you as state and local officials, and for our employers, to help people, again, just to come back to work and be part of society as safely as possible.

So in the setting of where we are and my concerns, getting to the third part, what is it that we can do? So I have three recommendations for state and local officials. And, again, happy to talk about this in much more detail. But three things. First is, I think we should prepare for a surge. That surge may come in the next few weeks given the reopenings and protests. I don’t think it actually will be substantial until the fall, when we could be hit with a double whammy on influenza season combined with COVID-19.

And if that’s the case, then we cannot afford to run out of masks, and ventilators, and personal protective equipment, and other supplies. We know that that could happen because it almost happened next time. And in fact, we did run out of PPE in many places and left our frontline health-care workers without the protection that they need. We cannot have that excuse again. That last time we could say we just didn’t know it would be so bad. Now we know this could be so bad. And we should not—we should be doing everything now to get ready for that surge.

Second, we need to develop public health infrastructure. Again, this is something that we know we need. We know we need widespread testing. We know that we need surveillance also. We cannot just be testing people who have symptoms. We should be doing surveillance—random population testing—to find out who has—or, who is—who is at risk in those at-risk populations, but also testing the population at large so that we can identify spikes before they become outbreaks, and outbreaks before they become epidemics. In addition, we need better demographic information for testing as well. We should not just be finding demographic information of those who get infected, but those who have testing to figure out if we are targeting testing to the right populations.

Then the other parts of the public health infrastructure are contact tracing and quarantining and isolation. One of the elements that I talked about yesterday during my testimony to Congress was exactly this. How am I going to tell someone who lives in multigenerational crowded housing that they just tested positive, they have to go isolate themselves and forgo their wages for two weeks? That just is not practical for many of the people who live in our communities. And we need to develop these types of capabilities as well.

Third component to this element of harm reduction is that now that we recognize people are going back to work, we are reentering society, we have to help our businesses as much as possible. CDC does lay out pretty good guidelines. I mean, they are qualified in a way that I’m not used to seeing from the CDC. For example, they’ll say things like: We encourage people to do social distancing. We advise masks, if feasible. I think these should be requirements, not just something to do if it’s feasible. But I do think that we can use them as guides on the local and state level for regulatory purposes too.

I think in terms of harm reduction we should also continue to do public education, again, making sure that we do not let down our guard. And ultimately, we cannot forget our most vulnerable. Actually, our most vulnerable are the ones who are going to be affected the most by COVID-19, as they are by all other unfortunate health conditions. And we need to even double down and address these long-standing disparities that have plagued our society for so long.

In closing, I just want to say that this is a new disease, which is hard for us to imagine given how much our world has changed in the last six months. But we were not talking about COVID-19, we didn’t even have the name COVID-19, six months ago. We have as a nation failed on many levels when it comes to addressing this disease as early, as urgently as we could have. But we need to look forward, not backwards. We need to think about this is where we are now.

Maybe we don’t agree with all the decisions that have gotten us to where we are, and it is true that hindsight is 20/20, but given that we are where we are now your leadership is needed more than ever to get us to a place where we can contain COVID-19 as much as we can, and recognizing that our individual efforts are going to be reflected in the collective efforts and the collective results that occur, and where we will go from here.

So thank you very much, and I turn it back over to Irina for your questions.

FASKIANOS: Thank you very much for that. And after this call we will be sure to circulate your testimony, which I’m sure is online.

So let’s go now to the group for their questions. And we also want to hear what you’re doing in your communities. This is to be a forum to share best practices and exchange ideas.

(Gives queuing instructions.)

And the first question comes from Dr. Paul Hendricks. And please accept the unmute prompt.

HUGHES: It looks like we’re having some technical difficulties with that, Irina. We can go back to Paul.

FASKIANOS: OK.

Let’s go next to—thanks, Maureen—let’s go to Michael Cahill.

Q: Hold on just a second.

FASKIANOS: Are you there?

Q: Hello?

FASKIANOS: Yes. We can hear you. Perfect.

Q: OK. Great. Thank you. Thank you for doing this and thank you, Dr. Wen. My name is Michael Cahill. I’m a state representative from New Hampshire. And we’re opening things up I think rather too soon. Next door to us is Massachusetts, which as many larger—more cases. And we were reluctant about the beaches, but today the government says you can go to the beach, and put out your towel and blanket, and have crowds. And not everything, but I think we’re opening too soon.

I’m also concerned about the testing, because you say testing, testing, but the tests themselves are not reliable. So you could have a test that might tell you you’re negative or your positive. It’s kind of fifty-fifty. So that’s where we’re going on this. We’re getting testing. Most of the fatalities have been in the nursing homes, congregant housing, like that. But people are ignoring the fact that the young people are dying from this, or they’re getting very sick and having kidney damage. And they’re just thinking that it’s only the old people, so why can’t I go out to a restaurant, or go to the beach, or do whatever I want to do?

So those are my concerns. Mostly the testing, because I’m alarmed because most of what I’ve read about the antibody testing or even the nasal swab that the president’s visiting today, they’re not accurate. And you could be—or, even if they were accurate, you could be having the infection, what, two days later, and then you’re positive. So where are we going to end up with this? Thank you.

WEN: Yeah. I mean, this is such an important question. And I’m glad that you brought up the issue of testing because I actually—as much as we’ve been talking about it, I don’t think that we’ve been talking about it enough. And so let me first of all distinguish between two types of tests, because this is really important and all of you will be asked, I’m sure, questions from your constituents and those you serve as well. There is the PCR test and then there’s the antibody test. The PCR test if what looks for if you have an infection right now, right? So if you have symptoms, and you’re going to the doctor to see if your symptoms are coronavirus, that’s the PCR test. The antibody test looks to see if you’ve had exposure before. Maybe you had COVID-19 before and just didn’t know it, or you had symptoms before, and you want to know whether you had coronavirus.

The antibody test I would not recommend right now for really anyone, and I don’t think should be counted as part of the testing that’s done, because the antibody test, to your point, I think, is the one that’s really unreliable. There are a lot of tests out there that are basically a coin flip. You can’t even tell. I mean, if you get a positive result or a negative result, it’s basically a tossup as to whether it’s accurate or not. So obviously I don’t think it’s particularly reliable. Also, we don’t know at this moment if antibody means immunity. So you could well have a positive test, but we don’t know if you’re protected against getting COVID in the future. So it’s not a particularly useful test.

The PCR test is a useful test. And actually, the reliability rate for that test is much higher. What we need to know is that there should not be a high false positive rate, which—so we need to—and also, obviously, you don’t want to a high false negative rate either, because you don’t want to be accidentally told that you’re negative when you’re not. But that test is relatively reliable. And now there are increasing numbers of these tests that are being produced, especially rapid tests that are produced the same day. So I think it’s critical to scale up production of that test, and to have it widely accessible, because ultimately testing is really critical to getting the economy back and to getting people reassured that they can go back to work and kids can go back to school.

FASKIANOS: Thank you.

I’m going to try to go back to Paul Hendricks. And we’ll see if it works. OK. Maybe you could type in your question since the audio doesn’t seem to be working. You can put it in—respond to Maureen’s chat to you.

And let’s go next to Suzanne Howard.

Q: Hi. Suzanne Howard from Sharon, Massachusetts.

And I’m interested to know what your thoughts are about schools starting in the fall, and what are some of the key things that school administrators can do to keep the children and the staff safe.

WEN: Yeah. It’s a really great question. And the second part of the question is actually easier to answer, because the CDC has put out detailed guidelines. And I would, again, just recommend for everyone if you have questions about how to best advise the institutions, the entities in your communities that the CDC website does actually have very good guidelines about it. So for example, some of their guidelines include looking at staggered start times, spacing out desks six feet apart, trying to do as much outdoors as possible. Not having lunchrooms, but instead serving lunches with disposable utensils at kids’ desks. I mean, things are really practical that I think are useful. Even on buses, I mean, there are some guidelines around assigning students spaces on buses that may be helpful too. The American Academy of Pediatrics I think also has some good guidelines in this regard as well.

Now, the first question is harder to answer, which is: Is it safe for schools to reopen? And I will say that at this moment it’s hard to say that anything is safe. There are things that are safer than others, but nothing is 100 percent safe. Just like there’s nothing that’s 100 percent risk. It’s not like whatever you do will definitely give you coronavirus, versus nothing is going to protect you 100 percent from it either. I think that that needs to be a decision that is carefully weighed. Obviously, there are many downsides to keeping kids out of school too, including widening educational disparities and, for many kids, how schools are maybe their one safe place, and the place where they get meals and social supports. And so I think this is a really complicated issue. And it’s going to depend on the risk/benefits for each—for each individual community and the—also the rate of transmission that’s happening in your area too.

FASKIANOS: Thank you.

Let’s go next to Rod Cleveland.

Q: Hi, Doctor.

My question is, as an elected official—I’m a county commissioner in Cleveland County, Oklahoma. And one of the frustrations that I had as an elected official was, I guess, the Privacy Act or, you know, the HIPAA laws, and getting the information that we need to get to set public policy for where the infections were happening at, where they were—you know, where we’re getting—what might have been the hotspot in our county? Was it—was it isolated? And as it ended up, we’ve had a lot of long-term care facilities—that was 60-65 percent of our cases. And we didn’t know that for the longest period of time, so that we can make determinations as to public policy.

So going forward to contact tracing, that seems to be the buzzword. But how can we get that from our health departments, so that they can get it to us, so that it’s public knowledge then and everything and stuff, so that we can actually be able to use it for public knowledge, not just for kind of research and for the health side?

WEN: So thank you for that question. And I think that there are two components of this that I want to—that I want to separate. And please tell me if I’m misunderstanding it. I think there are two things. One is how can we identify hotspots so that we can act on these hotspots? And then I think the second thing is on contact tracing. And maybe there’s a third component of HIPAA too, which I can also address.

So the first thing is, I do think it’s important that we look to see in each community what are the areas with congregant living that are likely to be the highest rates of infections, such that when there is one case there is often ten, twenty others among the individuals who are there and the staff as well? Nursing homes, jails and prisons, homeless shelters are those settings where there actually should be regular, ongoing testing of these sites because, again, once you find one positive, you can almost be certain that there are many other positives too. So I think that if that’s not already happening in your communities, you as an elected official can ask that there is surveillance testing happening in these particular settings. Because I think that is just really important to identify.

I think the second issue is separate. The contact tracing should not be made—I mean, you know, contact tracing already is hard. Contact tracing already depends on trust of individuals to tell you all the places that they have been. Sometimes there are sensitive areas that people have been. You know, you could imagine that somebody may not want maybe their spouse to know that they were with somebody else. Or you know, they might also have been involved—or they may have been when they were supposed to be at work. Maybe they were in places where they shouldn’t be. I mean, that contact tracing really requires that the individual is totally honest with the person that they’re speaking to.

So if that information is somehow disclosed the public, you could imagine that that would then shut the individual down and they wouldn’t want to disclose that information. So that’s why it—I don’t think that the right answer is that we should make that kind of information public, but rather that we should make the surveillance information—the things that we talked about in the first category of the surveillance of institutions—make that information available so that decisions can be targeted and interventions can be targeted accordingly.

I do think though, just one point about HIPAA, I think HIPAA is often misused as a concept. That so often data are not collected under the auspices of HIPAA, when actually HIPAA is meant to protect the individual, not the collective of the data. And so I think when in doubt you can always consult with the state’s attorney general or other state legal entities to help to discern. You know, I know that as a former local official I often had people telling me, oh, I can’t give you that data because of HIPAA. But that’s an easy cop out—(laughs)—for lack of a better word, when people don’t want to give you that information. And so when in doubt, you can always consult your legal entity to figure out if you actually can get access to that information and HIPAA is just being used as a—as an easy excuse.

FASKIANOS: Thank you. Let’s go next to Representative David Tarnas.

Q: HI. This is Representative David Tarnas. I’m from Hawaii.

And I’m really curious about your suggestions for making our air travel safer. We’re currently requiring a fourteen-day quarantine for any traveler coming into the state. We need to reopen, but we’re trying to figure out how to do it safely. Should—you know, is testing a possibility? And if you get tested negative, that you don’t have to quarantine? Or any suggestions?

WEN: Yeah, it’s a really good question. But here’s—and I think here’s the problem with all this: There’s still a lot of unknowns and I think a lot of barriers that unfortunately are still in the way. I mean, I would love to see a situation, right? We don’t have this—this is my ideal. I would love to see a situation where we have widespread enough testing that, let’s say, when people enter an aircraft, or when they plan to go back to work, or when they plan to go back to school, they’re able to get tested. And we can do that regular testing. You can’t just have the one-time test because you could be negative today but be positive next week. I’d love to have widespread testing for us to do that, and for us to make decisions accordingly.

Unfortunately, we don’t have that. We have screens that come close, but not quite. As in, we can do temperature screening, we can do symptom checking. They don’t come nearly close enough to the type of sensitive result that we would get from testing. And so unfortunately those results are not totally reliable. And that’s why I think we have to rely on these other things in the meantime. We have to rely on airlines enforcing policies on masks, doing temperature checks themselves, and symptom checks themselves, doing deep-cleaning protocols. I think though that in the meantime because we don’t have that widespread testing on the front end or on the back end, self-quarantining is still the most useful tool, as is, unfortunately, trying to limit not essential travel. I think that that’s still going to be the bedrock of our response too, that companies that don’t need their employees to travel should continue to limit air travel, which I think actually makes it safer for everyone too.

FASKIANOS: Thank you. Let’s go next to Robert Melanson. Please pronounce your name correctly for me. (Laughs.) Sorry for butchering it.

Q: OK. It’s actually Melanson from Lafayette, Louisiana.

FASKIANOS: Thank you.

Q: No problem. Yeah, Lafayette Consolidated Government.

 One of the concerns I think everybody has is the obvious risk of a second wave. And one of the particular challenges we face here is, is there a possibility that a second wave could be hiding out in our most vulnerable populations? And I’m not necessarily talking about poverty-stricken populations, but non-English-speaking populations. I’ve heard very, very little in terms of how to reach out to these populations. And just in order to avoid reinventing the wheel, can you either—can you make a couple of comments about strategies, or can you refer me to resources that would give me information about how to reach out to these non-English-speaking communities?

WEN: It’s a really good question. And unfortunately I don’t have a great answer for you. One is because of lack of data. The data that we have so far for demographics, for racial demographics and geographical demographics even, are really limited. And that’s one of the problems. I heard yesterday that the statistic—I have not confirmed this myself but this at the congressional briefing yesterday—that only four states have required collecting racial demographic breakdowns for COVID-19, which is obviously a big problem. And then you’ve got further problems. For example, the Asian-American Pacific Islander community tends to be grouped together all in one, which isn’t particularly helpful as another example.

So I think we’re missing a lot of data about the impact on non-English-speaking communities, though one would certainly anticipate that there are huge disparities in that population for all the reasons that you mentioned. For language reasons, because these individuals also tend to be essential workers. Also there may be fear of authorities and fear because if immigration fears, and other things. So I think that they key is going to be relying on the local health department and local community-based organizations that are seen to be the trusted messengers. And so this will be particularly important I think for contact tracing purposes. And I think at the moment there aren’t a ton of resources available for this, simply because I think this is a neglected area all throughout our country.

FASKIANOS: Thank you.

Let’s go to Gregory Rose next.

Q: Dr. Wen, thank you for having this forum, first of all. I think it’s been very helpful, at least for me. I had a—my name is Gregory Rose. And I am the city management for the city of University City in Missouri.

I had a question because we are challenge with whether we should or should not open our pools. And I don’t know that I have enough information relative to whether you can actually contract COVID-19 in the water. So I guess I was curious as to what your position is on the opening of pools and water parks, and whether indeed you can or cannot contract coronavirus in the water.

WEN: That’s a great question. And actually I’ve been asked this basically every time there’s a town hall or an event of some kind, someone asks this. So I’m really glad that you’re asking it.

So there’s a straightforward answer and a not-so-straightforward answer. The straightforward answer is, no, you cannot contract COVID-19 through the pool water. It’s not transmitted that way, as far as we know. So that’s a straightforward answer. The more complicated answer is that pools tend to be areas where people congregate. And places where people congregate you could—of course, that would increase the chance of transmission significantly. And also we know that this is a virus that’s primarily transmitted through person-to-person contact. So if people are standing in close proximity to each other for a long time, they could give it to each other that way. I cough, the droplets land on you, you get sick.

Also, it’s transmitted secondarily, but still transmitted too, through surfaces. So you could imagine that at a pool where there are lots of different shared surfaces, where there are loungers, and tables, and cups, and other things that different people are touching, bathrooms, faucets, doorknobs, that those could all be areas for transmission too. I think if you are going to be opening the pool I would say the most important thing is to limit capacity, and to keep up that social distancing somehow. So you could make it—you know, some ideas—you could make it a 20 percent capacity. You could limit the number of people entering. You could have people signing up in advance that they want to enter, and only be there for a short period of time. Like, a family could sign up for an hour at a time instead of going for the whole time. And also making it clear that the high-touch surfaces—like doorknobs, faucets, et cetera—that people need to clean them or wash their hands after touching them, or that they also need to be—and that they need to be sanitized by someone working there as well.

FASKIANOS: Thank you. Let’s go to Doug Glaspell next.

Q: I’m Doug Glaspell in Montrose, Colorado.

We’re beginning to get a lot of negative feedback about people who are saying either on the internet or social media about masks not being healthy for you and wearing of masks may cause you more illness than what it’s giving you for protection. Have you heard anything on that?

WEN: Yeah. I mean, I was asked this question earlier today. And frankly, it’s surprising because it’s just not true, right? It’s not true at all that masks somehow make you sick. In fact, it’s quite the opposite. So a mask—I do think it’s important to point out what a mask does and does not do. So we’re talking about the cloth face covering, a surgical mask, you know, just something that you wear that covers your mouth and your nose. The idea of a mask is that it protects you—or, rather—that it protects other people from you, if you happen to be an asymptomatic carrier of COVID-19 and just don’t know it. The thing is, if everyone wears masks, then we all protect each other from each other. And studies have shown that universal mask wearing with reduce COVID-19 by at least 50 percent. Some studies show that it’s up to as high as 90 percent.

So I just—I say this in the context of imagine if there is a vaccine that’s able to be distributed right now that lowers your risk of getting COVID-19 by 50 percent, maybe 90 percent. Wouldn’t everyone want to get that vaccine now? So knowing that that’s the case, we should all be wearing masks when we’re going to be around other people, because it reduces the risk of COVID-19 for everyone around us. So it’s just not true that somehow it makes us sick or something else. I do think we should emphasize, though, that masks are not a replacement for social distancing. So I do get concerned about this. Some people think that, well, now I can be around other people, and play with my friends, and go to school, if I wear a mask. That’s also not true. A mask is not a panacea. But it is important for reducing the rate of transmission. And all of you, as your local leaders, as state leaders, the people that others turn to for information, you could help us to spread accurate information.

FASKIANOS: Thank you. I remind everybody to raise your hand to ask a question.

And we did we hear from Dr. Hendricks. His microphone is obviously not working. He’s a county health officer in Hamilton County, Tennessee. And he wanted to ask whether antibody tests might be an appropriate surveillance tool to detect where the virus has been. I know you touched a little bit upon this, but if you have anything to add that would be great.

WEN: Yeah. I mean, so antibody testing could be useful for your understanding and my understanding as local, state officials, as public health experts, because that just—that gives us a better idea of potentially what percentage of the population in your area has had COVID. That’s interesting, and good for us to know, because that gives us public health surveillance information. I would not recommend antibody testing for the individual, as in if an individual wants to know have I been—am I now protected from COVID because I now have the antibody. That’s what I would say don’t do the test without reason, because I don’t want someone to get the false reassurance that they can go back to society and they’re safe, when actually we don’t know that information at all.

FASKIANOS: Great. Thank you very much. Looking to see if others have questions.

I have a question. If you were in your former job as the health commissioner—(laughs)—how would you—what would be the first thing you would be doing—or, what would you be doing now? You know, any sort of practical things if you were in that seat right now, beyond what you’ve already shared with us? Oh, there you go.

WEN: I think a lot of people want clarity. I think that actually—you know, I hear—and I was asked this yesterday too, about, well, shouldn’t—why should there be federal guidelines? Local officials know the best. And that’s—and we need for local officials all to be—you know, to be—to be responding to the needs of their communities, because they know the best, because they know their communities the best. I mean, agree with that, of course. Our local communities know the populations that they serve the best. But actually guidelines are really helpful and empowering.

I think at this point I’ve talked to so many businesses in Baltimore and around the country that just want that clarity. They want to know, if I follow those fifteen steps I can at least relatively safely reopen? Again, knowing that there’s no such thing as zero risk. But if I follow these—if I have a checklist of twenty things, and I can do this. It also, frankly, gives them cover because they can say: I follow these best practices. And if somebody still gets sick, I did my best. And now I’m going to follow these next ten steps for what happens if somebody gets sick in my establishment. And so what I would be doing is coming up with these checklists and guidelines, based on the CDC guidelines, but tailored for my community.

And, again, I think that these guidelines, these checklists, are really helpful and empower businesses. Everyone wants to do the right thing. I don’t know, and I’m sure all of you agree, I don’t know one business owner who wants our employees to come back to work and get sick. My husband is a small—is a small business owner. I’m sure—you know, nobody would want, you know, their customers to come back, or employees to come back and become ill as a result of our actions. And so having those concrete guidelines would be really helpful. And I think also a lot of public education is also what I would be doing now—what I am doing—but I think what all of us should be doing now as local and state leaders.

FASKIANOS: Thank you. Let’s go to Henry Granison please.

Q: Yes. Can you hear me?

FASKIANOS: We can.

Q: OK, thank you. Thank you, Dr. Wen.

I was wondering what you think—in your former job—what do you think of the issue of limited liability in terms of what you’re just talking about, the guidelines for jobs, whether or not we could also, you know, limit the liability of businesses or whatever to prevent them from being sued.

WEN: Yeah. I mean, this is a great question. And I do wonder about this. I mean, I’m not a lawyer and so can’t—you know, I don’t know if what I’m about to say is legally accurate or not. I have no idea. But this is, again, why I think the guidelines are so important. I think that businesses, from what I understand, are looking for this kind of guidance so that they could say, hey, look, I did my best. You know, we’re—all of us are swimming in the dark a bit here, right? Like, we don’t know a lot about this virus. We think that we’re operating based on the best available science, but that best available science is also changing all the time. Also, you could be following all the right guidelines and doing all the right things, but someone could still get sick, and could even get really sick, and succumb, and die from COVID-19 too.

So I think that’s why having these guidelines would be really helpful. I know that in past outbreaks when I was the health commissioner it was really useful for us to always fall back on the CDC and say, hey, we followed the CDC guidelines here. And businesses would then be able to say, hey, we follow the health department’s guidance here. And so, again, I think—I don’t know the legal aspect of this, but I would imagine that having those checklists, those guidelines in place also provides some level of cover for businesses too.

FASKIANOS: Leana, before we go to the next question, you said that you were surprised that the CDC guidelines weren’t as specific in some areas as they potentially could be. Is there a group of physicians working to come up with, you know, some additive—I mean, the CDC is our source—but some supplementary guidelines that state and local officials could turn to or think about? Or is that not happening?

WEN: As far as I’m aware, no, because this is just not what—nobody that I know, no public health expert that I know wants to override the CDC, because we—the CDC is our gold standard. And we’re used to turning to the CDC. I mean, in the middle of Ebola, Zika, measles, whatever other outbreaks we’ve had before, I went to the CDC website every day, maybe every hour, to look at their guidance. I mean, we don’t—that’s their job. They are the best of their kind in the world for translating scientific evidence or scientific studies into practical guidelines. That’s what they do.

Let me clarify though, Irina, because I think you brought up a good point. I’m not saying that the CDC guidelines aren’t good. I’m saying that they are qualified in a way that I’m not used to seeing from the CDC. There are so many guidelines that will say things like “if feasible,” “if possible,” “when possible.” They are encouraged, not required. So I would just say take out all those qualifiers and you’ve got yourself a great set of guidelines.

FASKIANOS: That’s a great point. And I’m glad that we both clarified.

Let’s go next to Alicia Lekas.

Q: Hello. This is Alicia Lekas, state representative from New Hampshire.

And my question has to do with herd immunity. I have heard that now being summertime is a good time to be open and let people develop herd immunity before the flu season in the fall starts again. What do you think of that?

WEN: I’m really glad that you asked the question because I want to make it very clear that herd immunity is an extremely dangerous concept when applied to COVID-19. So herd immunity refers to the idea that if somewhere between 60-80 percent of the population get a disease, then you protect the entire population from it. That’s what happens with vaccines. If you’re able to vaccinate a large—a percentage of the population, potentially there are some people in the population who cannot get the vaccine for some reason, and you’re able to protect them too.

I understand why it’s an attractive concept. If it actually is true, let’s say, that—if it’s true, which it’s not. But if it’s true that there is a certain percentage of the population who get really sick from COVID, you can shield them and everybody else can sick, and maybe they don’t get that sick. And so you can basically say, let’s get herd immunity and protect all those people who otherwise would have gotten really sick. That’s an attractive concept to think about. And I think that’s why there is—there are theories around this. But it’s not true. And here’s why: We don’t know that you actually get immunity from COVID-19. We don’t know this. We think that maybe you get immunity, but we don’t—based on other coronaviruses—we don’t think that you get immunity for very long. And the immunity may not be complete.

So the idea of getting 60-80 percent of America really ill where the mortality rate is 1 percent, and potentially young people are dying also of this really mysterious illness that causes toxic shock and multisystem organ failure, and we’re talking kids who get this, and people in their 30s and 40s are getting debilitating strokes and ending up in ICUs and potentially never speaking again, and making that kind of huge sacrifice and getting all these people sick, for the possible concept that maybe they get immunity, we can’t do that. And so I really do not—I think it’s important that we all say that herd immunity is not something that we can strive for because of how dangerous it is, and how unlikely this is to happen.

FASKIANOS: Thank you. Let’s go next to Susan Albright.

Q: Hi. I’m on the city council in Newton, Massachusetts.

And our state guidelines in Massachusetts for daycare requires more space than daycares really have available currently. And it requires keeping children six feet apart. It requires little children wearing masks. And I’m just—it feels like the people who made these guidelines may not understand children very well. I’m wondering what guidelines you might have for children in daycare.

WEN: So I have a toddler who is three, almost three. And so I speak as someone who—at least, I understand toddlers, and I understand daycare, and little children on a very personal level. I also have a baby too, but that’s a, you know, different conversation. If somebody has a baby question—a two-month old also. But the—so the question about daycare, you know, it is really hard. You know, I am not at the moment sending my toddler to daycare, and actually have a hard time imagining what kinds of things have to be in place for that daycare to actually be safe, because little kids, I think to your point, asking little kids to practice social distancing is just—I don’t know how one actually does that. Little kids also, as much as I want to tell my son sneeze into your elbow, don’t touch surfaces after somebody else touches them, that’s just not going to happen.

So I think what’s happening with the guidelines, like you’re describing, is the best-faith effort at trying to do these best practices. It’s they’re trying to do this, right? They know that kids are not always going to be staying six feet apart. But the least we could is to reduce the capacity and have more—and have a better student to faculty ratio so that they can at least try to separate children as much as they can. I do think that wearing masks is something that they—is something that everybody should be doing. Kids above the age of two should be wearing masks.

And you know, I think that there’s some other things that daycares can and should be doing. Again, the CDC outlines this very well. For example, removing all toys and objects unless they can be easily washed and sanitized. Trying to, again, stagger out the recess time and play time, so that—and then wiping down pretty frequently the high touch areas. So I think that there are common sense things that can be done while also recognizing that it will be really difficult to keep little people apart from each other.

FASKIANOS: Thank you. While we wait for others to queue up I wanted to ask if you could talk a little bit about where we are on vaccines.

WEN: Yeah. So we are—there are a lot of clinical trials that are ongoing for vaccines. And I’m glad that you asked this question, because I think there’s a lot of news also coming out all the time about this. So it’s important to clarify where we are. Dr. Tony Fauci has said that the soonest we—that it’s possible that we would have a vaccine in a year. I mean, that is an extremely optimistic timeline. That would require us to achieve something we’ve never been able to do in all of humanity. I mean, we’ve—the quickest, I believe, that we’ve developed a vaccine in the past is five to six years. And so doing this in a year would be extraordinary. Is it possible? I would never want to contradict what Dr. Fauci has said. I would just say that it seems—it seems like it’s extremely optimistic for us to meet that deadline.

Also, it’s not just developing the vaccine. We also have to manufacture hundreds of millions of doses of this. We also need to ensure that this is something that is actually safe and effective, because the last thing that we want is to give credence to the antivaxxer movement and have people say, oh, well, this vaccine caused all these problems. We don’t want that to happen. And then also at the end of the day, we also need to gird ourselves for what happens if the vaccine is not 100 percent effective. The flu vaccine, for example, is 40-60 percent effective every season, and we have to take it every year. I think it’s possible, if not likely, that the same thing might happen with the COVID-19 vaccine. That it may provide protection partially and for a short period of time. And we need to—maybe we need to think about this more—less of a vaccine as a cure all, and more like we have to be living with this disease, and vaccine will help us to better do so.

FASKIANOS: Are there any lessons that you’ve seen of what other countries are doing that we could look to?

WEN: Yes. Other countries have been effective in containing COIVD-19. And I think it’s actually—it helps as a way for us to think about this, because there’s a lot of people who say, well, no matter what we do, we can’t contain this. Well, that’s just not true, because other countries have been able to contain COVID-19. That’s the combination of testing, contact tracing, isolation that has—that has worked in other places. I think other countries have also shown us that social distancing measures work when they are applied, and when they are applied early. And so that’s important for us thinking forward, as we are now reopening. But might we need to reimpose these restrictions moving forward and remembering that early surveillance is important and applying these actions early is going to be important too in our response.

FASKIANOS: And are you confident that—or, are you hopeful—confident might be too strong a word—that we are shoring up our PPE and all the things we need if/when there might be a resurgence?

WEN: No. There has not been a coordinated national strategy from the beginning. And you, as local and state and health officials, I think have seen this firsthand, of what happens when states are bidding against each other for ventilators. When in my state—I mean, I couldn’t believe this—when my governor had to secure five hundred thousand tests from South Korea. I mean, why are states negotiating with other governments about this? And securing—after securing these five hundred thousand tests, it was reported at least, that these five hundred thousand tests were kept locked up by the National Guard to protect the federal government to confiscating the state supplies of tests. I mean, who would think that’s a thing that happens? I’ve watched also as my colleagues ran out of masks, and gowns, and goggles. And my—and nurses were asking over Facebook for people to buy masks at Home Depot and Lowes and lend it to them. I mean, how is that a thing?

And so I’m still not confident that we have a national strategy for coordinating supplies should there be a surge in the fall. I actually don’t know that there’s even agreement by our federal leadership that there is going to be a surge in the fall, and that we should be doing this work. So I am really deeply concerned. And that’s why I’m urging for all of you—you know, we’re all about practical solutions. If we’re not going to be seeing this work done by the federal government. We need all of you to step up even more to do this. And I recognize that that’s not ideal, and that you all have been doing a lot. But that’s, unfortunately, the situation that we’re in now.

FASKIANOS: And is there any—I know state and local officials—is there any place where there is a sharing across states, because so much has been done state-to-state, to share the information, share the data on contact tracing? Where is all that information funneling up and going to?

WEN: What do you mean? Can you say that again?

FASKIANOS: I just want to make sure there are no other questions. Is there a place where state and local officials can consult and confirm best practices across—you know, because it seems that everything is state by state, in addition to the CDC, of course, but.

WEN: Yeah. I mean, I think that there is a lot of—again, a lot of great work being done on the local and state level. And a lot of data collection being done that’s really exceptional. But ultimately, this needs to be a national effort.

FASKIANOS: OK.

So we are almost at the end of our time. And I just wanted to ask if there were two or three things that you wanted to leave the group with.

WEN: Clear, direct communication is critical. And your role as the leaders that your community turns to is absolutely essential, number one. Number two, do not let down your guard. This is a time where we should be on guard even more than before. The virus is still as contagious as ever. And with reopening, it means that we are going to see more transmission occurring. And third, be ready, because we have not seen—we’re still at the beginning of this pandemic, and we are going to be living with this for some time to come.

FASKIANOS: Thank you, Leana. That was—that was really terrific, to have you with us for this hour. We appreciate it. Glad we got through it without your child waking up from the nap. So thanks to all of you for being with us. We really appreciate it. We hope that you will follow Dr. Wen on Twitter at @Dr.LeanaWen. We will send a link to the audio and transcript of the webinar to you all soon. But please continue to reach out to us by sending an email to StateAndLocal@CFR.org if there are areas that you want us to cover or issues that we should dig deeper into. And again, please visit CFR.org, ThinkGlobalHealth.org, and ForeignAffairs.com for the latest analysis on COVID-19.

So thank you all. Thank you, Dr. Leana Wen. We appreciate it.

WEN: Thank you.

(END)

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