‘This Is Not a Public Health Crisis — It’s a Political Crisis’

A conversation with Stanford epidemiologist Dr. Steven Goodman

Back in March, when the Covid-19 outbreak was in its early days, I asked my brother Steve to join me on the public affairs radio show that I host, The Vermont Conversation, to talk about what we could expect with this new virus. Unlike me, he is an expert. Steve Goodman, MD, PhD, is an associate dean at Stanford Medical School, where he is also a professor of epidemiology and population health and medicine. I wondered aloud whether closing schools was an overreaction. He quickly set me straight.

“This is an impending catastrophe,” he presciently said. “We have a tsunami that is rolling in. The depth of the ocean at our feet at the beachhead is only a few inches right now, but it’s rolling in.” We spoke again in late April about the dangers of reopening.

Today, with 140,000 Americans dead and millions infected, I decided to seek out Steve’s epidemiological perspective on where we are and what lies ahead. You can listen to our live radio conversation here. This transcript has been edited for length and clarity.

Elemental: Vice President Mike Pence recently declared, “We slowed the spread. We flattened the curve. We saved lives.” How do you assess where we’re at now?

Steve Goodman: I think the numbers speak for themselves. We have by far the highest number of cases in the world and the most deaths in the world. But it’s important to recognize that this disease is still a pretty local phenomenon. So, to ask, “How is the United States doing?” is not really the right question.

What we have in the United States is not just 50 different stories for the 50 states. We might have 500 different stories, because every county has a different policy. This is part of the problem. When you look at the maps, they’re like a checkerboard, even within states that are doing terribly. There’s a county in California, for example, that has no cases. Zero. And yet California right now is said to be doing rather badly, because there are some areas of California that are doing terribly. Overall, the problem is we have so many population centers that are exploding right now.

Four months ago, it was really just New York that was exploding. Now we have explosions in areas of Florida, Mississippi, Arizona, California, and Texas. It’s very hard to keep track of the epidemic because of the proliferation of local epicenters. In these places, the hospital systems are becoming overwhelmed. Once again, we are seeing exactly the kind of terrible pictures that we saw in New York, and before that, in Italy and in China.

“What we have in the United States is not just 50 different stories for the 50 states. We might have 500 different stories, because every county has a different policy.”

Back in March, you could reasonably assume that public health would work in the way that it’s supposed to, with testing, tracing, and containment. Where did you expect the United States would be by the summer?
That seems like a lifetime ago. I will tell you where I didn’t expect us to be: where science and numbers would play almost no role. Right now, we have one of the worst states, Florida, where the governor is still saying, “We don’t need to wear masks.” People go about their business. In many cases, politicians are trying to hide the numbers coming from the hospitals. One of the tragedies here is that people don’t see the people dying in the hospitals. They’re sequestered away. So, unless people understand what it means to have a hospital system that is overwhelmed, it might be an “out of sight, out of mind” sort of thing.

I did not expect that basic public health measures and looking at numbers would become political. I did not expect that wearing a mask would be political. Dr. Anthony Fauci is just citing the numbers, and he’s getting pushback — and worse. This is no longer really a public health and scientific crisis. It’s a political crisis.

We know how to suppress the virus. Look at what we did in New York, in Italy, in China. There were major conflagrations, and we beat them back. Every other country, except perhaps Russia and Brazil, has done what we did in New York and kept it at a reasonably low level. But we have not, and each county is fighting this on their own, so the fires keep burning, and they’ve even accelerated.

Florida has just set a new record of more than 15,000 infections in one day — more than all of Europe combined. How do you bring a raging infection under control, especially when it’s taking a week or longer to get testing results?
Well, we got it under control in New York without the amount of testing we have today. We know exactly how to do it: It’s social distancing. It’s wearing masks. And at this level of prevalence, it’s staying home. We have learned that we can safely engage in certain kinds of activities, mainly outside. The science has moved to focus more on airborne transmission than surface-borne. So, certain kinds of lockdown measures maybe aren’t as necessary as long as we don’t crowd closely together and wear masks and are respectful. We just need the political and personal will to do it. It can’t be up to individuals. This is what leadership does. It gets people to work together toward a common goal.

“We know how to fight this scientifically and medically. We don’t know how to do it socially and politically.”

I keep wondering if Winston Churchill, in his speech before the Battle of Britain, instead of saying, “We will fight them everywhere,” said, “You each decide whether you want to fight them on the beaches, in the streets, or in the hills. I’m not going to tell you what to do. Just get a gun and decide how you’re going to fight them off.” I wonder if he would have marshaled the collective efforts of the British people in the same way.

We know how to fight this scientifically and medically. We don’t know how to do it socially and politically.

There’s a big question about whether people who get Covid-19 are subsequently immune to the virus. What do we know about immunity right now?
The simple answer is we don’t know. What we do know is that most people develop measurable immune responses that seem to last for a while — a few months at least. But there are other people who don’t mount very robust responses. We’re getting some reports of people who seem to be infected more than once. Whether they just represent people who never mounted an initial response, or whether their response waned after just a few weeks or months, we don’t exactly know. The consensus at the moment is that you get at least a medium duration of immunity.

Remember, this virus has only existed for six months, so we can’t have answers about whether immunity can last a year. We are learning in real time.

What is the status of testing? It seems we’re still in crisis.
This is one of the incredible disappointments, along with personal protective equipment, which is still in shortage in many of the hot spots in the South. It’s like we’re a developing country. We had the warning flare. We didn’t learn from China, and then we didn’t learn from Italy, and then we didn’t learn from New York. I mean, where do we have to learn from? This is what the absence of central leadership gets you. We don’t have enough testing, and we don’t have fast-enough testing. And we have to wait too long for the results of many tests in many areas.

We’re not within a light-year of where we need to be — which is testing on demand with results within a day. Then people who have been exposed can know: Are they a threat to others? There actually was a complaint from Mick Mulvaney, the former White House chief of staff, after his son couldn’t get a result for five to seven days. Well, that’s virtually useless if you’re exposing somebody for that week. So, we’re still in a miserable state. We’re not catching up to the need.

“It’s the virus that’s making the decisions. When we cede control to the disease, the disease takes over. That’s what shuts down our economy.”

Against this backdrop, we’re talking about students returning to colleges and K-12 schools. What do you think is the right approach to opening schools?
Some of the data from Europe suggests that schools are not as big a threat as we might think. But in almost all those cases, the prevalence was not where it is in some of the places in the United States. The CDC has actually put out some pretty reasonable guidelines about how to safely open schools. These are being completely ignored by the leadership in Washington. I think if we adhere to those guidelines, we’d be in an okay place.

It’s the virus that’s making the decisions. When we cede control to the disease, the disease takes over. That’s what shuts down our economy. It’s not political decisions to protect us that shut down the economy.

Large parts of the United States seem to have essentially abandoned public health. If so, what has replaced it?
The public health professionals, as well as the clinical professionals, the doctors, and all the ancillary staff working to save lives — none of them have given up. They’re pleading with the political leaders to take the steps needed to protect both their patients and them. Commonsense public health measures like masks have been politicized. It’s almost criminal. It’s a shame. And anybody who doesn’t embrace such a simple, cheap measure to protect the health of their own constituents is abandoning public health.

It seems there is no good news right now. I’m wondering where you find hope in the middle of this crisis?
Improved treatments are emerging almost every week, and the recent early vaccine results are encouraging. On the public health side, I find hope in places like Vermont, where things have been kept under control. New York went from a forest fire to very little, in a place where it’s incredibly difficult to control contact between human beings. So, I still believe that we have the wherewithal and the means to control this. It’s a matter of our political leadership recognizing that it’s not a hoax, that the virus itself has economic impact — and that the lives of the people they represent matter.

NYT bestselling author. Journalist. Skier. Host, The Vermont Conversation podcast at VTDigger.org. www.dgoodman.net

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