Reporting on COVID-19

Tuesday, September 14, 2021
Pool New/ Reuters

Senior Fellow for Global Health, Council on Foreign Relations

Health Reporter, Iowa Public Radio


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


Adjunct Senior Fellow, Council on Foreign Relations

Luciana Borio, senior fellow for global health at CFR, provides an update on the virus, including information on vaccinations and the latest variants. Natalie Krebs, health reporter at Iowa Public Radio, shares best practices for reporting on COVID-19 and how local journalists can cover this issue in their communities. Carla Anne Robbins, adjunct senior fellow at CFR and former deputy editorial page editor at the New York Times, hosts the webinar.


FASKIANOS: Thank you. Welcome to today’s Council on Foreign Relations Local Journalists Webinar Series. I’m Irina Faskianos, vice president for the National Program and Outreach at CFR.

As you may know, CFR is an independent, nonpartisan organization and think tank focusing on U.S. foreign policy. This webinar is part of CFR’s Local Journalists Initiative created to help you connect the issues you cover in your communities with national and international dynamics. Our programming puts you in touch with CFR resources and expertise on international issues and provides a forum for ensuring best practices.

Today’s webinar is on the record and the video and transcript will be posted on our website after the fact at CFR.org/localjournalists.

Today we’ll talk about reporting on COVID-19 with our speakers Luciana Borio, Natalie Krebs, and Carla Anne Robbins. We shared their bios with you so I’ll just give a few highlights.

Dr. Luciana Borio is a senior fellow for global health at CFR. She is also a venture partner for Arch Venture Partners and an adjunct assistant professor of medicine at Johns Hopkins University, and she was most recently a member of President Biden’s transition COVID advisory board. She also has served at the NSC where she coordinated the response to the Ebola epidemic in West Africa.

Natalie Krebs is a health reporter at Iowa Public Radio. She previously worked as an independent producer in west Texas covering issues from immigration at the U.S.-Mexico border to environmental issues in the Permian Basin. Her reporting includes coverage for NPR, WYFI, and Side Effects Public Media.

And our host, Carla Anne Robbins, is an adjunct senior fellow at CFR. She’s a faculty director of the Master of International Affairs Program and clinical professor of national security studies at Baruch College’s Marxe School of Public and International Affairs, and previously she was deputy editorial page editor at the New York Times and chief diplomatic correspondent at the Wall Street Journal.

So thank you all for being with us. I’m going to turn the conversation over to Carla and then we will open it up to all of you for your questions and for you to share best practices in your communities.

So, Carla, over to you.

ROBBINS: Thank you so much, Irina.

And thank you so much, Natalie and Luciana, for joining us, Dr. Borio who has agreed to—(laughs)—be called Luciana. But thank you so much, both of us (sic), for joining us today.

And thank you so much to all the reporters on the call for joining us today as well.

You know, we’re just going to have a conversation up here for a while and of course please jump in; you know, let us know that you have questions, because I’m sure you have a lot of them for both of our—for on-the-ground practices of reporting and expertise, so it’s, you know, an ongoing, rather grim topic and an incredibly important one from a news point of view, and thank you for all that you do as reporters.

So, Luciana, can we start with you with something of a national overview? I mean, how much of this is déjà vu all over again? The numbers I saw this morning in the Times show an average of 172,400 new cases of—plus 8 percent over the last fourteen days; 1,827 new deaths, which is up a 36 percent increase over the last fourteen days. And more than anything else that’s really scary is that hospitals in the South are reporting a severe ICU capacity issue. The Times is reporting that in Alabama all the ICU beds are currently occupied and that in Texas 169 hospitals have ICUs that are more than 95 percent full, up from 69 (percent) in June; there are only about seven hundred intensive care beds remaining across the entire state. It sounds really scary. How different is this surge from last year’s surge?

BORIO: Yeah, so it feels that way sometimes, like a déjà vu, but I think that in reality things are much different and that we have a segment of the population, the vaccinated population, that is actually much better off. You know, they’re very protected. They tend to be more cautious. They tend to wear masks. And then we have a very dire situation for the unvaccinated. And unfortunately, that—you know, there are people in that category that are doing this not by choice but because they don’t have access to vaccines yet. Right? The children, for example. But for the adult population for which vaccine is available and highly safe and effective, the situation for them is indeed dire. And, you know, it’s not—and fortunately, too, we do see the spillover, if you will, into—it impacts other people’s lives, even the vaccinated, because, you know, the more cases that are circulating in the community, the more breakthrough cases there are, children get affected, health care systems get strained. We know of stories of people having trouble accessing medical care. They get displaced. So of course it impacts everybody. But, by and large, we’re having two different populations. From one side, things look pretty good, and for the other, the situation is dire.

ROBBINS: And have doctors at least gotten better at treating the people who get sick? Not that that’s an argument for getting sick, certainly not an argument for not getting vaccinated. But we’ve certainly learned things since the last surge.

BORIO: We have. And there are therapeutics available, and the monoclonal antibodies, you know, if given very early, can actually further decrease the risk to those who may get exposed, especially if they’re vaccinated. The people that are really dying from this disease when they’re vaccinated right now are really the ones who have—the most vulnerable population—the older, elderly; there’s, like, you know, much older, and those with severe immunocompromising conditions. So treatments have gotten better as well. Unfortunately, the system is still not perfect, and I know from personal experience in my patients at Hopkins that sometimes there’s such a lag in being able to access the therapy that the patient is feeling better by the time they’re called in for the therapeutic, for the infusion. So things are not quite yet perfect, but things are available.

ROBBINS: And are they available? I mean, this is—I remember when President Trump got sick, you know, and he was saying this is not a big deal, and they of course had thrown absolutely everything at him. But a lot of this stuff at that point was experimental and certainly not accessible by most people who got sick. It was, it seemed to me, that those were treatments for sort of the rich and the famous. Has it now gotten to the point that if somebody gets sick that they have, you know, access to the monoclonal antibodies? I mean, are these things much more widely available than they were six months ago?

BORIO: That’s right. They are. And every locality is managed in a certain way, so Maryland, for example, and Baltimore, close to our practice, they are sent to the—you know, I forget now the convention center or—you know, there are infusion sites, and it varies. But there is a referral that is required by the treating physician, so you can see that there is a little bit of lag in the system because a person needs to be symptomatic; they need to be tested; you need to—confirmed the diagnosis through test, and then they have to meet a certain criteria for risk factors, and then the doctor has to actually fill out the form. It’s not that bad; it’s online, at least in Maryland. But there is a delay in the system and that’s—it’s not as seamless as it could be.

ROBBINS: Thanks.

So, Natalie, what are you seeing on the ground? I mean, how is this fall different from a year ago, and how much of a challenge are you facing as a reporter in making what is a relentlessly grim story but that for many of us feels like we’ve seen this before?

KREBS: Yeah. I mean, I was seeing kind of what the rest of the country is seeing, an uptick in cases, an uptick in hospitalizations. I mean, much like a lot of things Luciana said, it’s different this time in the fact that a lot of the concerns over the unvaccinated this round—I’m thinking of this time last year. There was just a lot of concern in general about spread and keeping distant and just keeping everyone, you know, healthy and keeping everyone apart. So it feels a lot different, again, too, where there’s sort of this choice at the moment of getting this vaccine or not getting this vaccine and we’re seeing high numbers of those who are not fully vaccinated who are being hospitalized now. Demographics have changed again. Before that was older people, people in nursing homes; that was what we saw last year.

It’s—the challenge continues to keep telling stories. I mean, it is a grim story and it’s—I think we see COVID fatigue. I certainly am COVID fatigued, but again, with seeing the numbers, seeing the increase in hospitalizations, it’s just important to continue to tell stories, continue to tell what’s going on out there. And I think I have found with this vaccine angle and the difference between the way the pandemic looks now with the vaccination issue, it does make for fresh stories. It is looking at the pandemic from a different angle. Now we’re looking at combating vaccine hesitancy and some of the issues that vaccine hesitancy has caused, you know, such as, you know, concerns over staffing shortages and such, too, and hospitalizations for, you know, health care providers who are concerned about losing employees to vaccine mandates.

So yeah, it’s grim out there but, again, it’s just something where I find—it’s just—it’s a really important health story and just to continue to follow what’s going on.

ROBBINS: So let’s continue that for a while because it seems like you’ve got really good story ideas for people—(laughs)—always looking for great story ideas. So vaccine hesitancy would seem to me—would be—there’s a political story here, obviously, which is, what are we hearing from our political leaders? What are we hearing from our community leaders? Who’s pushing out what disinformation? Where are people hearing this from? What’s the reinforcement versus the other side? You know, who are the community leaders who are trying to combat vaccine hesitancy? That would seem to be one bucket of stories. You’ve got the whole staffing issue, which is really an interesting one which I hadn’t thought about, which is true for health care but it’s true across the economy, and which is going to lead into a question I want to ask Luciana about, sort of, what’s it’s like to be in government and make a decision about mandates? But we’ll move onto that really quickly.

And so there’s that. And so what other sort of stories do you—are you finding that you weren’t doing last year that go on around this vaccine hesitancy issue?

KREBS: Right. It’s just added sort of the psychology of the vaccine hesitancy issue. So you’re right. There’s one thing that—it’s what leaders say and we’re kind of taking that approach. You know? Our governor hasn’t issued mask mandates. She’s been really resistant. She’s really taken the approach of, you know, again, encouraging Iowans to wear a mask, encouraging Iowans to get vaccinated, over any kind of mandates. And I think—so I—looking at it from the other side is sort of, you know, who are these people who are hesitant about the vaccine, which is something I’ve followed for months, you know. You know, we see these numbers in polls and so many people aren’t getting the vaccine. You know, it’s putting faces to sort of those opinions and seeing what’s going on. The other part is sort of, what kind of issues does this cause? And so, again, looking at health care workers, there’s a chronic shortage of health care workers in Iowa for various reasons and, you know, my latest story, I was just thinking that I knew that there were health care providers out there who are concerned, you know, about issuing mandates just because they know they’re going to lose employees out there. You know, at the same time, it’s just sort of the impact of vaccine hesitancy too; you know, how is that impacting schools as well? And so I find—I kind of tend to look at it from that angle too, which is, what issue is vaccine hesitancy cause—what other kind of other, you know, less obvious issues is it causing out there?

ROBBINS: So Natalie said, you know—mentioned her governor, Governor Reynolds. He (sic; she) was one of many Republican politicians who denounced President Biden’s latest vaccine mandate as, quote, “dangerous and unprecedented.” I mean, let’s face it: Vaccine mandates are not unprecedented. I mean, all of our kids—(laughs)—when they went to school had to be vaccinated. I don’t get the danger part of it. At the same time, it took a really long time for President Biden to do this.

Luciana, you’ve worked at the NSC. You’ve worked across government. What do you think the debate was? Was this a political debate? I mean, from a public health point of view, do you think they waited too long on the mandate?

BORIO: You know, Carla, so let me just first observe that the levels of hesitancy have not really dropped significantly and it’s on par with Russia, which is completely absurd when we think about it because, you know, the Russians have a reason to be hesitant about their vaccines. (Laughs.) They don’t really have, you know, studies that are rigorous and that meet scientific integrity and that, you know, the vaccine is not that effective anyway, and we have no idea about how safe it is because, you know, they haven’t really done this, they haven’t published reliable studies. So Americans have—you know, we are the envy of the world in terms of the safety and effectiveness of our vaccines, and here we are—so there’s something that I think, you know, we need to figure out and I don’t know what the answer is. But I don’t know that we have put the best of our brains together to really figure out how to overcome this. It doesn’t have to be this way. It’s not like the law of physics. But, you know, like, the doctor in me saying there’s a symptom that is really—there’s something really wrong about the situation. And we’re left to explain the problem—oh, it’s polarization; it’s politicization; it’s, you know, it’s—I don’t care what it is. Let’s do something about it, right? We can communicate. We can clear things up. I think we need to do better because the other countries in Europe, for example, the hesitancy rates are going down.

ROBBINS: Are they doing things differently from we are? I mean, is it that they’re less polarized, or are they doing—we certainly do see a considerable amount of populism and polarization in countries in Europe. Do you know what they’re doing differently?

BORIO: I do not know what’s accounting for that. I think that there’s some elements in Europe that are just as polarized as we are; some areas, I think we’ve heard today that there is—I think in France there is a new news network that is kind of mimicking some of the news networks we have, you know, in the U.S. So it’s a matter—but, you know, the graphs are pretty striking when you look at the rates and putting us together with Russia, and I think that we need to have, like, an all-hands-on-deck because that’s the reason why we don’t have more people vaccinated right now.

I think that the issue of mandates is really problematic. I mean, I’ve been on record, you know, early on that I don’t think that it was really helpful because I wasn’t sure that—early on that—wasn’t sure how effective these mandates would be. But I think clearly now people are just out of ideas and desperate to get more people vaccinated, which I completely understand. There was a hope that with the FDA approval of the vaccines, the licensure, that more people would agree to be vaccinated and that more employers would be willing to mandate vaccines. And clearly, that didn’t really happen. And the fact is that, you know, there was a lot of push to get them to the finish line more quickly, which, you know, gives a lot of heartburn to folks like me who spent so many years at the FDA because you really don’t want to use the regulatory process for anything but to review the scientific review of the product, you know, and don’t want to accelerate things on the basis of a different motive. And the fact is that it was accelerated. We knew the vaccine was safe and effective but it was a very rushed—not—rushed is the wrong word. It was a very accelerated process. I’m glad it’s approved. I’m glad it’s licensed. But the fact is that we—if we observe now, you know, it didn’t have the impact on vaccine uptake that we had hoped, and now I think they’re going on to this last straw. Something has to be done. So I don’t know—I don’t have an answer because I think it’s—I had a position in the last year that I always—didn’t think that this was going to be that effective. I think they’re trying everything they can. You know, government has tremendous power. Right? Like, it’s incredible, like, the authorities it has, the resources, the brain trust. It can bring a lot to bear to a given problem. And I think in this instance hesitancy should not be something that we should say we just accept it and say, you know, we’re just going to let it be and that’s how it is.

ROBBINS: So, Natalie, when you talk to people—two things: Have you talked to people who were vaccine hesitant and who have changed their minds? And do you know what it is that changes their mind? I mean, is it speaking to a faith leader? Is it seeing a family member get sick? Or are people—is nobody changing their mind of the people you’re talking to?

KREBS: Yeah. I’ve spoken to a number of people who are vaccine hesitant, not so many that have changed their minds. But what I have kind of learned from my research is it’s kind of—I mean, all of the above is what you said. There’s a big push to kind of reach people in small groups, so that’s through faith leaders, you know; that’s through their doctors. There’s a really big push to reach people through their primary care physician, so basically the whole trusted leader thing, so, you know, rather than just kind of pointing to the CDC and saying, you should follow what the CDC says; they’re experts; they’re really important and said—you know, targeting people who they know—and, again, that could be their church leader; that could be their doctor. I know the state—the department on human services here, you know, they have had some success. They’re unable to have a vaccine mandate for their six facilities they run right now. They were having really low vaccination rates. They’ve had some success, you know, arranging small groups that include, you know, the state medical director, union leaders, and then just, you know, other people from their facilities to tell stories about getting the vaccine, why they got the vaccine. And that’s—so there is this kind of push to, you know, to try to get people vaccinated by having them encouraged by people that they know. So yeah, I’ve heard of people changing their minds because a family member got sick, because they got sick, or because, you know, they just talked to someone in the community that they trusted or even that they just looked at statistics and were just concerned about the number of people hospitalized who are unvaccinated. But at the same time, too, you do have a solid group of people, like—you know, Luciana said with vaccine hesitancy rates that just aren’t changing their minds; they’re seeing statistics, people talk to them, and they’re still—you know, they kind of—they believe they have their reasons and they’re sticking to them.

ROBBINS: So it seems to me that there are two big stories that are going to unfold and that are upholding in front of our eyes right now. One is the reaction to the mandate and the other one is kids going back to school. And so in some states kids have been back to school for a month already; in other states, like New York, they just went back this week.

So, Luciana, from the perspective of a doctor and the perspective of a mother, what should we be reporting on the return to school to see both whether or not school districts are taking the right precautions, how they’re handling the return to school, and as well as the impact of the return to school on people’s—on public health. What would you as a reader like to see? Because you can’t go everywhere to check on it so we as the, you know, the eyes and ears for that—and so looking at that, both as a mother and a doctor, you know, what stories should we be writing?

BORIO: Yeah, I think—you know, people sometimes feel really helpless about, like, it’s not under control. I mentioned, like, you know the movie, the real bad movie, like, Bird Box that was on Netflix a little while ago—it seems like—(laughs)—this is a Bird Box situation. It’s not the case—it’s a virus with a—it’s a virus, you know, with physical properties; we know how it’s transmitted. And there are things we can do. And I think that making sure that adults understand that they have a role to play in keeping their kids safe—right?—the community of adults around those children that cannot yet be vaccinated matter, that the more that are vaccinated the better off we all are; our kids are safer. I think that—especially teachers that are interacting with them daily. Then there are these extra layers: masks and air handling in schools and some spacing, some cohorting, diagnostic testing deployment. Some schools are doing pool testing, which is, you know, really interesting. I think that all of those don’t have to be—you know, it doesn’t have to be all or none, but there are layers of, you know, tools that one can deploy, and I would want to know, you know, what is the school deploying? Are they (requiring ?) vaccines for teachers? If not, what’s the percentage of the teachers that are now vaccinated? Are they—cohort of the kids—are they wearing masks? Are they enforcing it? Are there educational messages for the children? Are they doing testing, et cetera? That’s what I would want to know.

ROBBINS: So cohorting and pool testing—do you mean, like, swimming pools? (Laughs.)

BORIO: No, I’m sorry about—


BORIO: The surveillance means something to the FBI that is different from the CDC.

ROBBINS: Right. (Laughs.)

BORIO: So pool testing means that they would—so they can—an example of pool testing is that all the kids in a classroom can swab their noses or spit or whatever the test they’re using and the one—the test—it’s one test that is sent out for analysis, very quickly turned around, so it saves resources. If that’s positive, the whole class, you know, gets tested and they’ll switch off to remote, if you will. So they’re doing little—some schools are doing strategies like that and keeping that group together, just to be able to make it more manageable, you know, to deal with outbreaks within the school.

ROBBINS: And cohorting?

BORIO: Cohorting is when you group kids together, so—pods is the other way to call it, like, you create some pods within the school and, you know, we know that if there’s a little outbreak, it’s more likely to be limited to that little—to the cohort, the pod.

ROBBINS: So you’ve given us basically a checklist of things that as a reporter we could go to a school and ask them how many of these things are they actually doing, and if they’re not doing them, why are they not doing? Is there anything else you’d put on that checklist?

BORIO: No, I think that those are the key elements, and I think that’s a great way to think about it, a checklist. And again, it doesn’t have to be that everybody will, you know, use all the checklist, but—because the most important, really, is about vaccination, you know, vaccination in that community. But I think that people should have, you know, a responsibility for figuring out, like, what is it that, you know—how are we protecting these children? It can’t be a situation where they say, well, we’re doing nothing; we don’t want vaccine; we don’t like vaccines; we don’t like mask mandates; we don’t like testing, you know, and therefore we’re fine with just having these children, you know, develop serious infections, potentially life-threatening infections, and you know, and heart impacts in their life—you know, myocarditis that can—the virus can cause. I think that’s not something that we should just accept again as the status quo.

ROBBINS: So I want to go back to Natalie and then I want to turn it over to the group. But the amount of information that’s available and the frequency with which it’s doled out really varies enormously from state to state. That’s very political. But if you wanted to assess the impact, for example, of the return to schools on a county level, just to see how well is my county doing, where would you get that data from? And if your county or your state is hesitant or resisting giving that information, do they have to report it to the federal government with some frequency, and is that a way to get that data if you’re not getting it easily out of your state government?

KREBS: Yeah, so the CDC has a lot of county-level reporting and I will say here in Iowa they are reporting county-level data and then they’re also reporting new COVID infections by age group, and one of those age groups is zero to seventeen, so that’s what I’ve been using to kind of track school cases. We don’t have, you know, a database here that reports school outbreaks officially from the state. And so I think what me and other reporters have kept an eye on, basically, is just how many zero to seventeen cases. And it’s been up to like a third of the new cases every week, and that’s much higher than we were seeing before.

But yeah, to say—I think there is—if your state doesn’t have that information, there is information available at the CDC on a county-level basis, and you can find some information on your state through that.

ROBBINS: Great. Well, it is—we’re twenty-seven minutes into this so I—group, your reporters, we want to hear questions from you. We have—yes?

FASKIANOS: Yes. All right, so people can raise their hand by clicking on the raised-hand icon, or you can also put your question in the Q&A box, and if you do that, please also type—share with us what outlet you report for. And we’d love to hear from you and any challenges you’re experiencing as well, and don’t be shy, so.

ROBBINS: While you think about why you’re not going to be shy, since I always have questions, but I was—wanted to go back to Natalie and just ask her a question about—how hard are you finding it to get people to talk about this? I mean, it’s such a politicized issue. Are people, you know, so angry about it they don’t want to talk? For example: the mandate issue. Are you having a hard time getting business leaders to talk about it, workers to talk about it?

KREBS: It can be hard. It really can be hard to find people to talk about this. It is kind of a sensitive topic. For the last story I did on kind of the issue with health care worker vaccine mandates, I actually—there’s a couple anti-vaccine protests going on around—at hospitals around Des Moines, in particular, where I live. And I went there not really knowing if I was just going to find, you know, sort of this group of people who kind of lobby the state government regularly, you know, list some of their anti-vaccine legislation every year, but I happened to find a number of health care workers, people who were RNs or worked in hospitals, who were, you know—you know, didn’t want to get the vaccine; they’re very anti the COVID vaccine and were looking at possibly quitting their jobs if they were going to be required or not get an exemption by November.

You have to look at different ways. You know, I definitely—when I’ve been looking at hospitals across the state, just called many hospitals and a lot of hospitals don’t want to talk but you will find them—across the state you’ll find someone who will be willing to talk about what’s going on there, what sort of issues they’re facing. I found a hospital in eastern Iowa this time, you know, talking a little bit about that struggle that they have with not wanting to issue a mandate because they’re afraid of losing their employees to another hospital. A lot of hospitals I spoke to wouldn’t want to really say that on the record. And so, yeah, sometimes it just takes calling around looking for protests, sometimes looking for people who are willing to speak. And honestly, Twitter’s been really handy at this time, too, kind of looking for people—I have a number of Iowa followers and you can find—there are a lot of people who are willing to share their opinion out there, if you’re looking for them.

ROBBINS: Luciana, can you explain—it would seem to me on the vaccine hesitancy issue, and certainly for the people who want to politicize this, they’re always arguing that well, you really can’t trust the CDC, you really can’t trust, you know, the people who are telling you what they’re saying because they change their mind all the time. You know, first they told us masks—we didn’t need masks; then they told us they did need masks. I mean, do you feel that—and some of this, of course, began during the Trump administration; there was a feeling that it was really being politicized, whether or not it was. Do you feel that this is just sort of the normal medical research process that hasn’t been—you know, the public wants certainty in a field that can’t guarantee certainty and that it’s just the communication on this has been poor? Because now it’s coming down to this issue of boosters. I mean, President Biden told us we’re all going to get boosters. You know, I’m over 65. (Laughs.) I want my booster! Except now I’m being told that maybe I don’t need a booster; maybe a booster isn’t a good thing. Is this bad communications on the nature of science or something more serious going on here in the way our institutions are working?

BORIO: Yeah, I think—you know, it’s true that science evolves, you know, slowly, and information sometimes, new information can change, you know, from prior fact, you know, basically learn something new, sometimes a question of perspective. But I do think that it has been particularly challenging for both administrations, but including the Biden administration, to communicate facts, and I suspect that—you know, as always I’ll be, you know, very candid. I think that it’s been—you know, I’m really disappointed how the boosters topic has evolved because, you know, normally you really want to be able to rely on the technical staff, both at CDC and FDA, that have a deep understanding and a deep commitment to public health to be able to look at this data carefully and adjudicate, you know, what they’re seeing. They’re not—it’s not a—you know, these professionals don’t look at summary data; they don’t look at the summary data that is in a medical journal. They look at the raw data. They do their own analysis. They go very deep to say, you know, are there confounders that may be impacting the conclusions? It’s just a—it’s due diligence. And this doesn’t seem to have happened in this instance. So I think there was a process foul where the administration was consulted with the most senior physicians, they signed on to a statement that boosters—initially, actually, if you go back a few weeks, Israel and Pfizer says we’re going to do boosters and they were like, no, no, no, you know, it’s going to be up to the government, not Pfizer and Israel. The data is flawed; the data is confounded. But then shortly after, there was—everybody fell in line and they signed on to the statement, and the scientists who’ve been doing this for decades and they really understand, thought that, you know, this may not be quite—it’s been reported, you know, quite the way we should be doing this. And at the end of the day, it’s possible that boosters are the right thing to do, but we should only be reaching this conclusion once there is a thorough evaluation of data and a public discussion, which isn’t from the advisory committee that is happening on the 17th so that people can actually have a thorough understanding about the pros and cons and the trade-offs associated with boosters. And in this instance, this process wasn’t truly followed.

So I think we’re seeing, like, you know, we’re in this complicated situation right now and I don’t know what the solution is. I think that I’m a little bit—I’m very comfortable that most healthy adults who received two doses of the mRNA vaccines are very protected. I think that it’s unreasonable to expect the vaccines to remain highly effective against infection, not—for severe disease, you know, they’re holding up pretty well, but it’s unreasonable; that’s not how these vaccines work. We were, in a way, very naive to think—to hope for that, you know, when the trials are very compressed and numbers were artificially high early on. We got really happy about it. But, you know, the vaccine folks knew that that was not going to last forever. And we can boost but—and, you know, how long will that improvement in antibodies last and protect? I think we have to be more careful in the evaluation of data and decision making around this.

ROBBINS: And, I mean, we see that people don’t trust institutions more generally and people aren’t particularly well trained in science in school these days, and you add those two things together and any change in mind leads to this further mistrust. On the other hand, we believe in transparency, so it makes it more confusing.

But we have questions, so let’s go to the questions.

BORIO: I’ll just say, Carla, this—you know, it’s such a difficult situation for the technical staff that is involved in this kind of review because they are keenly aware that, you know, they have a job to do; they have a commitment to the American public, and they’re keenly aware that any messaging that introduces any doubts around—about these attributes, about these vaccines, plays right into the hand of anti-vaxxers and it really is agonizing to be able to do your job in this kind of environment.

ROBBINS: So Robert Cheney has a question.

Rob, do you—or Robert, do you want to voice your question or shall I read it? I’d much rather have you voice it. We can unmute you.

Q: Hello.


Q: So parallel to the vaccine hesitancy, I’m really curious if there is an infection hesitancy in the sense of people unwilling to return to especially front-line worker jobs or people unwilling to send their kids back to school because they’re afraid of infection. Especially on the worker side of things, I frequently hear this as an economic argument, that people are too cushy with their unemployment payments and so they’re just not bothering to go back to their Uber driving or their restaurant work or whatnot. But anecdotally, I’m hearing a lot that people are just—they are not willing to put up with that risk of infection. However, I’m not seeing anything, either data or other sort of research-backed look at this, that would underpin that kind of an argument, and I’m wondering if anybody else has seen that out there that is significant concern that I don’t want to get back out into the social working world because of the risk of infection.

KREBS: Yeah. I mean, I can answer. I think that’s a really, really good angle I haven’t entirely explored, but yeah, I think we’re seeing shortages of restaurant workers and such here and across the country, and I think that hesitancy to go back to work because of infection is a really good story out there. I haven’t seen too many polls or anything that kind of fully explained why people don’t want to go back to work. I think it can be kind of hard to quantify that. But I think that’s a good thing to kind of explore and go behind some of these help wanted signs and talk to people about why they’re not going back to work, especially now that there’s, you know, so much more information about breakthrough infections and kind of this idea now that, you know, I think people kind of had this false notion of the vaccine kind of being this forcefield protection and it really just prevents you from getting sick or severely ill. You can still get a breakthrough infection. People are still worried about getting sick. So yeah, I think the employment angle, that’s a good economic angle and kind of—with the pandemic, especially at a local level.

BORIO: And I haven’t seen, you know, much of that either, you know, but I do think it’s somewhat justified for certain people. Right? Like, if you are somebody who has Type 2 diabetes, hypertension, single parent of a child that cannot get access to vaccine and you go into an office where people are saying masks optional and vaccine optional—like, you know, it’s a reasonable, rational hesitancy to have. Right? But it wouldn’t be, of course—but, you know, other people may—I think most workplaces are, at least in the workplaces that—(laughs)—I’m engaging with, I think they are a lot more protective and mindful of protection of their employee base.

ROBBINS: Luciana, how common are breakthrough infections? I mean, I saw—I’ve seen—read a few pieces on this and people crunching the numbers. I don’t think they’re all as common as—people talk about them a lot because people are surprised because we really did think, as Natalie said, it was a forcefield. But they’re not all that transcendently common these days, are they?

BORIO: Yeah. So they are quite—well, it depends on how you look at the data, and the way—you know, just to exaggerate the situation, I said, but if you have 100 percent of people vaccinated in a community, all the infections that occur are going to be breakthrough infections. Right? So the more people are vaccinated and—but not to the degree that they need to be able to quench the pandemic, so, you know, even if you have like 80 percent people vaccinated is not sufficient, you know, because the transmissibility of Delta. But a lot of cases are going to occur as breakthrough, but what matters is that, still, 95 percent-plus of people that are hospitalized are the unvaccinated. But one can play the numbers to make it sounds like it’s a bigger problem than it really is.

ROBBINS: OK. And anecdotally, I will tell you that, you know, when I found out that they had put back the deadline for—I thought all my students were going to be vaccinated and I found out that the deadline was kept doing—part of me thought to myself, hmm, really? I really want to get back in the classroom face to face, but hey, I thought I had a guarantee here. Maybe I don’t have a guarantee. So let’s just say I go to class an hour early so I don’t have to be on the elevator with a whole bunch of people. It’s my way of handling it. (Laughs.) I’m still going back in.

So we have Amy Rivers from the Waterloo—the Courier in Waterloo, Iowa. She’s in a busy newsroom so she’s—a crowded newsroom so she’s asked me to read her question.

“Hi there. I’m a journalist at the Courier in Waterloo, Iowa, and love following Natalie’s work.” I’ll just stop there so you can take that in, Natalie. (Laughs.)

“Was wondering, Natalie, how you were approaching the Iowa Supreme Court’s new temporary injunction on mask mandates. What are you hearing from schools as this information is coming out? Do you get the sense we will see a big school backlash to Reynolds’ mask ban mandate, or do you think they will be more cautious?”

Good question.

KREBS: Yeah. That is interesting.

Hi, Amy. Thank you.

It’s interesting, too, because this is sort of the next chapter in what I’m sure you’ve seen has been kind of the battle between, like, school districts, like particularly Des Moines, and the state. You know, last year, Des Moines, you know, was really concerned about virtual in-class, in-person learning. The state, our governor, had, you know, at one point banned in-person classes. Des Moines had gone virtual. They were kind of in a big fight over whether or not those days would count. So now with the Supreme Court decision, this temporary injunction, we’re kind of seeing the next thing. This just happened yesterday. It’s been interesting. It doesn’t surprise me that, you know, some of the bigger school districts like Des Moines, Cedar Rapids have announced they’re putting in a mask mandate. Again, I think we’re still going to see what happens. I mean, I think it will be interesting the final kind of say on what happens with mask mandates when the court issues their final ruling as to whether that will be permanently reversed or whether that will go back into place. And I think that’s an interesting issue to follow in general, too, just because there’s been this bigger thing about local and state control going on in Iowa over who kind of has say in this public health emergency about what, you know, what people can do, whether, you know, some of these local jurisdictions like school districts, mayors that have authority over mask mandates and such, and so I think that final ruling’s going to say a lot for this pandemic and in the future about kind of how we handle emergencies.

So yeah, I’m kind of watching that unfold right now and it’s really interesting. But to me, again, it just seems like this kind of next chapter, and particularly a really very Iowa-kind-of-specific issue, and a couple other states, over, you know, who can dictate, you know, what to do or what safety measures to take in a public health emergency.

ROBBINS: Luciana, can we talk about the vulnerability of children? I mean, we were told—and this, of course, is very relevant with the return to school as well. We were told, well, we don’t have to worry about kids because they don’t get very sick or they don’t get sick at all, and now we’re seeing—you know, as Natalie said, you know, she’s been tracking those numbers very closely. I mean, how vulnerable are children, a) to getting sick and, b) how sick do they get? I mean, do we know—is our knowledge different from a year ago? Did we have a lot of false assumptions about the vulnerability of children to this disease?

BORIO: I think that with the vaccination of more adults, you know, the pediatric epidemic has really, like, has been unmasked. You know, it’s more visible. And I don’t have the latest statistics, to be—I just haven’t checked the latest, latest, but I think that’s—and of course we know that there’s a linear, like, relationship between age and morbidity associated with this virus. But, you know, in terms of kids becoming infected, we know that in a virus it’s—normally it’s a question of how they are—receptors in their nasopharynx that—the virus is not, you know—the Bird Box movie. Right? Like, it’s a physical—there’s physical properties. And the virus binds to receptors, and kids’ receptors tend to be a little bit different. They have a different density of receptors in their nasopharynx. So the virus tends to adapt over time to become more efficient and so that it expands its host range, if you will. So I think that Delta has demonstrated that it’s—you know, binds very avidly, replicates to very high levels in adults, and there’s no reason to think that, you know, kids are immune. I think that sometimes we have a little bit of magical thinking associated with these things, so I wouldn’t—you know, I think that we need to protect kids, for sure.

ROBBINS: And talking about Delta, I mean, it seemed like Delta came pretty quickly. Is there, you know—and it seems like Delta has been around, the dominant for quite a while. Is Delta just so strong that it’s just knocking off—(laughs)—all the other pretenders, or should we be expecting something scarier inevitably? I mean, what’s the nature of the evolution of these viruses, given the fact, particularly, that there are so many unvaccinated people around the world?

BORIO: Yeah, so it’s really difficult to predict. I think that most virologists who study the viral evolution think that Delta is here to stay and that the new viruses that might evolve will be sub-lineages of Delta. It’s very difficult to predict. A big surprise could happen. By no means is Delta the most transmissible or immune-evasive, you know, virus that one could imagine—(inaudible)—in terms of its R0 or its ability to evade immune response. So theoretically, I think it’s possible. Again, we’re better off. We know how to make these vaccines. We have therapeutics. We know how to mask. We know how to be able to minimize the intensity, duration, the number of social interactions we have in a way that is not needlessly disruptive, you know, lock in place. I don’t see this going back to that. But, you know, I think it’s—I think Delta is formidable and the curves are, you know, quite incredible how it really has displaced the other ones due to its transmissibility. I hope we don’t see anything worse than that, but it’s very difficult to predict.

ROBBINS: So, Natalie, I’m not sure—I saw this story; I’m not sure if you wrote it or someone else wrote it, but there’s all this money pouring in and—that is pandemic-related money, and I saw that Iowa was spending some of its pandemic money to advertise, what is it, tourism to Iowa?

KREBS: Yeah.

ROBBINS: (Laughs.) I’m not sure that was exactly what they had in mind when they passed that money. So I always think that money is a great story; following the money, big and small, is always a great story. So are you doing money reporting, either money that’s going for health care, money that’s going more generally that was supposed to go to health care that isn’t going to health care? Can you talk a little bit about that?

KREBS: Yeah, so, yeah, I do some. I work with our state government reporter a lot and kind of split duties, and this is, you know, such a big story and so entwined with state government. And I find it fascinating. I feel like I get involved with that element too, but yeah, that’s definitely something—I think that’s a great story to follow, especially here in Iowa there’s just that—again, that story they launched this tourism campaign, again, basically using federal funding. But then there’s been other questions lately; again, a lot of Democratic lawmakers have been pointing to the Republican government in Iowa and saying, you know, we—yeah—like, offered millions of dollars for school testing; you know, they haven’t taken it; it’s just sitting there. So yeah, to answer your question, there’s a lot of really fascinating, you know, federal, you know, funding money stories in Iowa right now. There’s been constantly this battle about, you know, where this money is going. I think at one point, too, you know, the governor turned back—turned down like $95 million in testing from the federal government just saying, you know, we’re good, we don’t need that right now. So I think, you know—I am constantly, just part of my job, following where the federal money is going and what it’s being spent on. That’s going to be something that’s going to be an issue for a while, something to follow for a long time.

FASKIANOS: Carla, we have a question. I want to just go to Amy Browne. She’s the news and public affairs manager at WERU in Orland, Maine.

Q: Hi. Thank you for taking my question.

I’m wondering if anyone is reporting on what percentage of the people in your coverage area are—who have been hospitalized are either uninsured or on Medicaid or Medicare. I typically cover the CDC briefings here that we have our state briefings and am starting to work on a story about that and have been surprised that there doesn’t seem to be a lot out there and the state doesn’t seem to be compiling that information specifically, so just wondering about the—if anyone is looking at the economic costs from that angle.

ROBBINS: Great question.

KREBS: Yeah. No, that’s a really good story. I haven’t looked at it specifically from that angle yet. I will say—I mean, Medicaid in Iowa was privatized a couple years ago. It’s been highly controversial. And so Medicaid is something I’ve followed in general. I know, too, that something I’m looking forward in the future, I think there’s a number of people who are going to be kicked off Medicaid that were kind of on, I think, during emergency orders under the pandemic—I need to double check that before I—(laughs)—put out into the world officially—by the end of this year, and so I think, yeah, that’s a really good point, too, to kind of, I guess, look at people who are on Medicaid and kind of how they’re being affected by the pandemic but also just how their health coverage is going to be affected.

ROBBINS: There is this—I mean, you hear this sort of muttering about, you know, this sort of “why are we paying the price for these people who’ve made a positive decision here, or a negative decision here, not to get vaccinated?” I mean, that this is—and there was that story, I think it was in the Times, about people in Washington state not wanting to allow people from Idaho to come in and overwhelm their hospitals. I mean, there is that weird, anti-immigrant thing that’s spreading here, which is really sort of nasty. And so I think there is, you know, a growing sense of that and that’s going to further sort of polarize the country. But it does raise a very interesting set of questions, particularly when you think about public health care. So there’s some really good stories there.

Luciana, you work in a hospital part time, among your many jobs. Have you noticed that this money has changed anything, the money that’s coming in, that’s the COVID money that people are getting even better at things? Are they finally using electronic records? (Laughs.) Are they getting smarter at things? Are there any stories to be tracking down in the health system itself about how the health system has been transformed by the pandemic?

BORIO: You know, Carla, I do the outpatient clinic at—(inaudible)—at Johns Hopkins and I don’t have very much visibility on the systemwide issues. I can say that I thought telemedicine is, you know, is here to stay. It’s a wonderful thing. It was really a lifeline for a lot of patients, but also, it reminded me how hard it will be to really scale it up to a lot of the most vulnerable populations that do not really have access. A lot of the telemedicine visits were converted to phone calls midway because of difficulty connecting to the Internet or clicking on the video link, so we’re a long—it’s one of those issues that I think further enhances, like, the disparity. It has a great promise for all, but, you know, we’re not quite there yet for a lot of the populations that really could benefit from that.

ROBBINS: So for reporters who want to look at how hospitals have adapted or not adapted over the course of the pandemic—I mean, I’m amazed, you know, at the notion of these ICUs being overwhelmed. Is that inevitable or is that poor planning? I mean, why weren’t they ready?

BORIO: Well, a lot of the ICUs across the country during “peacetime” and in the pandemic period are always—they’re usually—they run pretty full on a routine basis. So it doesn’t take much to overwhelm them. We haven’t seen—well, they’ve been—I think it’s been reported but, by—you know, like, anecdotes, but, by and large, they are at—over capacity but still within the planning ranges where you can, you know, give and take and activate surge and all that. I don’t think that there is much of an appetite to build a tremendous amount of capacity for very expensive care at this juncture when we know how to avoid that to begin with.

ROBBINS: But one would think that after—I was just thinking because we were on a walk over the weekend and we walked past New York Presbyterian and I was remembering what it was like a year ago when there were those, you know, refrigerator trucks out front in New York at the height of it and, I mean—and basically in front of every hospital in New York City, and about how now, luckily because the numbers are—they’re up but certainly far down from what they were a year ago. But if you’re in a state in which you are a hospital administrator, you had to understand the politics of your state, right? I mean, shouldn’t they have built up capacity?

BORIO: Well, they—you know, they say COVID is not that serious, not that real, that we—you know, “where’s the COVID?” in those states? Right? So it’s not a big deal; that’s why we don’t have to—kids don’t have to wear masks. It’s all optional. I think that’s—you know, I think it’s part of the mentality. And then, of course—and the ICUs are a little bit overflowing but that’s just part of how we deal with—that’s how I think—this is, like, completely—I’m just making this up, but that’s how I imagine this goes on. But from a health care system utilization, you know, it makes—there’s only so much surge capacity that is reasonable to develop unless—because it’s just so expensive to do and maintain, that those resources are much better applied in other areas of the health care system. And right now it’s fully avoidable with the vaccines that we have available.

ROBBINS: So do you have a checklist—and I want to go to Natalie—but do you have a checklist for reporters covering hospitals about how prepared they are to deal with these things comparable to your checklist for schools?

BORIO: I think it’s more about are they vaccinated—are they mandating vaccination for their health care workers to protect patients and the health care worker in the system, if they have protected workforce, they have staff. Staffing is a major issue. So that’s number one. If you’re going to want to surge, you need to have staff to do it, and have adequate amounts of PPE, and what are the plans to be able to do mutual assistance with regional hospitals? Because surges are sometimes—you know, it’s just part of crisis planning for hospitals. Those are the three things that I would want to know that they have in place.

ROBBINS: Great questions.


KREBS: Yeah, I was going to say, with the whole issue of hospital preparedness, I know in Iowa most of the hospitals here are critical access, which means they’re like twenty-five beds or less. And like I said, there’s chronic shortages of health care workers. So even before COVID, they were traveling—they were hiring traveling nurses to work here just because they couldn’t get enough nurses in the rural areas. So, you know, I think a lot of them are struggling with COVID now just basically because they didn’t have the resources before and, I mean, a lot of rural hospitals—they’re expensive to run. And we’re seeing this with OB units shutting down. They’re expensive to run, you know, so they end up having to shut them down because they just don’t have the resources to keep something like that running. So ICUs are expensive too. And, again, using the state I live in as an example, in rural areas you don’t get a lot of people in the intensive care unit and so it just ends up, you know—then a crisis like this hits and basically they just don’t have the staffing and the supplies they need at the moment. On top of that, you see, again, too, there has been, you know, cuts to public health funding at the state level for years. So these plans, these kind of crisis plans, aren’t really put in place or kind of pushed aside again during peacetime. You know, it’s something that’s kind of doomsday or, you know, fantastical and won’t ever happen, and then when it happened, you’re looking at a health care system that’s pretty easily overwhelmed. So yeah, that’s sort of what I’ve heard, too, just basically the structure of hospitals around the state.

ROBBINS: I would love to—and you guys have been great and I really, really appreciate it. I would love to go around and ask people, what have you learned? You know, I mean, what have you learned and how much of your, you know—if you feel that you haven’t been able to adapt your hospital or your school system or your business to deal with the pandemic like this, because, you know, odds are this isn’t the last time we’re going to have to deal with something like this. Why haven’t you been able to do it? Is it because it’s inadequate support from the state, from the federal government? You know, why—you know, fool me once, you know—(laughs)—second time around, shame on us, because we are in the second time around with this surge.

Luciana, this has been fabulous. Thank you so much, Dr. Borio.

Natalie, this has been fabulous. We should all—we will all be reading you and following you on Twitter.

And Irina, back to you.

FASKIANOS: And that’s a great segue to say thank you all, and you should follow everybody—Carla on Twitter @robbinscarla, Luciana @llborio, and Natalie @natalie_krebs. Please visit CFR.org, thinkglobalhealth.org, and foreignaffairs.com for the latest development and analysis on COVID-19 and international trends and how they’re affecting the U.S. And do email us, share suggestions for future webinars and speakers that you would like us to invite. You can email us [email protected].

So thank you all again for being with us and to our fabulous speakers.


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