A 98% Decrease in Daily COVID Cases (with Céline Gounder)

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Description

Andy calls up Dr. Céline Gounder, who just wrapped up a two-week rotation at Bellevue Hospital in New York City. They discuss her current COVID patient load compared to a year ago, the city’s new vaccine requirements, and her honest assessment of the Biden administration’s COVID record. Plus, why trust is so important when we ask people to do things like getting vaccinated for the common good.

Keep up with Andy on Twitter @ASlavitt and Instagram @andyslavitt.

Follow Céline @celinegounder on Twitter.

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Transcript

SPEAKERS

Andy Slavitt, Dr. Celine Gounder

Andy Slavitt  00:18

Welcome to IN THE BUBBLE. This is your host, Andy Slavitt. I have with me on the very good show today, Dr. Celine Gounder. You might know Dr. Celine Gounder, as some of you see in TV quite a bit. She is a doctor in New York. She’s an epidemiologist at the Grossman School of Medicine at NYU, and also Bellevue Hospital. She’s got a couple of great podcasts of her own. As I said, she was a big part of the Biden transition team. And we kind of start the conversation by focusing on what’s going on in New York, the first place in the country, where you get to show your own vaccine card to get anywhere to get anywhere, even the walk on the sidewalk, no, not to walk on the sidewalk, but to walk into a bar, to walk into a Fitness Studio. So we’ll find a little bit about how that’s going. Celine tells us something I found fascinating in her hospital Bellevue; it was pretty hard-hit last year when New York was hard hit with COVID they at one point had 600 people with COVID in their hospital at the same time. 600. She just did rounds this weekend, and she’ll tell you how many are there now, but I’ll give you four choices for you to guess. Okay. 6000. That’s a B. 6 million. c 12. d. 600.

Andy Slavitt  01:51

Okay, you got that? Your choices are A. 6000. We’re talking about how many people are at Bellevue Hospital right now, B. 6 million. If you never been to Bellevue, it’s pretty big place. C 12. D. 600. Okay, write it down. No cheating. And I expect you to get 100% on this test. I think you’ll know the answer, by the way, I framed the question. I want you to get it right. Pretty amazing. When you say pretty amazing things, they’re looking brighter. I mean, look, maybe temporary, but cases are dropping, cases are dropping like a rock in Florida. And we have a general sense of maybe a low, why? A lot of people have been infected with Delta. And a lot of people have been vaccinated, wish more people have been vaccinated. But if you add up the number of people that have had COVID, and you add up the number of people that have been vaccinated, you get to probably a pretty big number. I mean, there’s probably still 60-70 million people or so who have neither one has happened. But that’s okay. That’s okay. Because that number is shrinking.

Andy Slavitt  03:05

Now, I don’t know why you’d want to get COVID when you could put the mRNA vaccine into your arm. I don’t know why you’d want to rather have COVID because it’s more dangerous. It’s more contagious. It’s more imperfect. And you can you know, you just you’re spreader, you’re spreader, whereas if you get a vaccine, is it possible to spread? Sure. It’s possible you’ll still get sick. Sure. It’s just less likely. It’s just less likely. That’s the difference. Okay, I’m gonna dispense with the chitchat. I’m gonna get to Dr. Celine Gounder. As you heard from last Wednesday’s episode with Katherine Wu, just phenomenal people. interesting people. So glad you tuned in for this one. Enjoy.

Andy Slavitt  04:02

So good to have you here.

Dr. Celine Gounder 

Yeah, it’s great to be here.

Andy Slavitt 

How are you doing?

Dr. Celine Gounder 

I’m good. I just wrapped up two weeks on the wards at Bellevue Hospital. So I’m a little wrecked because it’s juggling that with the usual stuff. But I will say it was amazing to be there and see the contrast with a year ago. So we had over 600 patients. We were averaging in the six hundreds of COVID patients at the height of the pandemic. And over the time I was there for that two-week block. We had 12 COVID patients so I mean that’s remarkable.

Andy Slavitt

Wow. And what do you owe that to?

Dr. Celine Gounder 

Oh, vaccination, vaccination vaccination, you know, we are at over 70% of people over the age of 12 vaccinated in New York City now, now you know, there are patchy patchiness to that geographic differences. But you know, as a city, we’re doing really well and so I think makes a huge difference.

Andy Slavitt

Do you fear that there’s any calm before the storm? If there’s any wave coming into New York?

Dr. Celine Gounder

Well, I think how returned to school and in some cases return to the office plays out remains to be seen. And I think we will have a resurgence around the winter holidays hopefully won’t be nearly as bad as last year. But I do think we can expect to bump around Thanksgiving, Christmas and New Year’s.

Andy Slavitt 

But you expect to be modest relative to last year, or you expect it because of vaccinations or do you expected to get to some troubling heights in New York?

Dr. Celine Gounder 

No, I think it’ll be attenuated. But you know, those are also times of year when we’re relatively short staffed, because people want to go visit their family as well. So I think that needs to sort of play into how we prepare is just to make sure we have enough folks still around. So if we do have an increase in patients from COVID, we’re prepared.

Andy Slavitt 

So New York has just implemented probably some of the most stringent vaccine requirements in the nation. Actually, if you were looking around the world, they would be kind of more in the norm. But in the US, there’s sort of the extreme vaccination center required to enter certain establishments, restaurants, gyms, etc. Can you talk about how that’s working? How that’s taking effect? How people are reacting?

Dr. Celine Gounder  06:28

Yeah, so you need to show proof of vaccination in New York City. If you want to dine indoors, if you want to go into a bar indoors if you want to go to a gym indoors, and I think by and large, it’s actually working pretty well. There was one pretty well publicized altercation at Carmine’s restaurant on the Upper West Side, where some folks visiting from Texas got into a fight with a hostess who was looking to verify their vaccination status. But I think those kinds of altercations, confrontations have been pretty rare.

Andy Slavitt 

Because hostesses really deserve that, right? I mean, there’s not enough money in the world to like deal with some people from Texas, like trying to give you a piece of their mind about like, vaccine policy.

Dr. Celine Gounder

Well, don’t come to New York if you don’t want to play nice with New Yorkers, I guess.

Andy Slavitt 

I hope she gave it back as good as she got it. She gave a taste in New York.

Dr. Celine Gounder 

I know they got a taste of the NYPD.

Andy Slavitt 

Interesting. Like, it’s funny. I think the virus is a small problem. And we’re a big problem. Like if there was just a virus. And like we could okay, and there was no human element. We say okay, challenge, that’s dangerous, is that we deal with it. But man, mix that up with the human dynamic. Boom. It’s the virus’s best friend.

Dr. Celine Gounder 

Yeah, it’s really the human element that determines how well we cope with this. I mean, we’ve seen in countries where people trust one another, they trust the government, the government trusts you to do the right thing. Places like Denmark, for example, they’ve just done a whole lot better. I mean, it’s amazing. Over 95% of people over the age of 50 in Denmark are vaccinated, they are returning to pretty close to normal life. And that’s because people trust each other and work together.

Andy Slavitt  08:24

But they have no freedom.

Dr. Celine Gounder

I don’t know that sounds to me, like a pretty free place where you don’t have to worry about COVID anymore.

Andy Slavitt  08:32

Well, sure, it looks like freedom. But they don’t actually have freedom. Right? I mean, they don’t actually have complete freedom somehow, I think, I do my best Tucker Carlson. No, if I did my best Tucker Carlson, I’m just gonna you’re like, have you ever been on Tucker?

Dr. Celine Gounder 

I have not. It’s funny, I was scheduled to go on Fox a couple times last year, I think I ended up going maybe once or twice. And every time they would book me and then they would cancel, you know, most of the times. And then finally, I was like, you know, this is just not a good use of my time I could be doing something else. And so have said no, every other time. I mean, if you look at the data, they’re not a big fan of women doctors, period. And so I you know, I just didn’t feel like it was a really high yield to keep getting scheduled and cancelled when I wasn’t their priority.

Andy Slavitt 

Crazy. I mean, what was crazy to read that Fox news has a vaccine requirement and have one for a long time, I was shocked to read that.

Dr. Celine Gounder 

Yes. And they have a daily testing requirement if you’re not vaccinated, which is also amazing, daily.

Andy Slavitt 

Right. I mean, Tucker Carlson talks tough, but he’s a bad wetter. I mean, he’s just like, he’s a whiny, he’s a winey winey winey little squirrel.

Dr. Celine Gounder 

I couldn’t agree with you more.

Andy Slavitt 

That’s my diagnosis. So just I want to finish up on your comments a couple weeks. You just spent at Bellevue. Have you observed, how’s the nursing staff doing? How’s the turnover? How’s the churn? How’s the mood? And, you know, what? Are you seeing anything unusual in patients? you seeing any younger patients? Are you seeing any manifestations of the illness that are different vaccination status, etc?

Dr. Celine Gounder  10:18

Yeah, I think probably the most striking thing is the proportion of people hospitalized who are not vaccinated. And to be clear, they were not coming in for COVID. But I would say about half of my patients on the wards, and these are all adults, because I take care of only adults, were not vaccinated. And I think this really speaks to, well, the patient population we see at Bellevue is very much a Medicaid poor population, a lot of immigrants, a lot of homeless people. So in other words, people who face barriers to accessing health care. And so I think this really speaks to the fact that people like that still are having a difficult time getting vaccinated. And so every day, we would run the list with the residents. And I would say, okay, so and so gotten their COVID shot, let’s make sure they get their COVID shot while they’re here. So that was something that stuck out to me.

Andy Slavitt 

Got it. Okay, we’re going to continue this feature, which may be a silly feature, I admit, but it may be it’s a feature nonetheless, at least for the time being of our show, called, okay, let’s move on people. Okay, we thought that the vaccines were going to be better preventing infection and mild symptoms. Okay. Then Delta came in now we know, vaccines actually aren’t great at that. They’re actually great at preventing hospitalizations, but they’re just okay, preventing symptoms. Now, we know that, okay? I know, we were told differently. I know, you felt like someone told you something that’s no longer true. But can we move on people? Can we just move on? Like, tell us now about what the vaccines like from here forward? Forget about what we believed before. How do these vaccines work? And how effective if people are going to move on what should they know about the vaccines?

Dr. Celine Gounder  12:01

Sure. So, when you get vaccinated, you have a big surge in your antibody levels. And at the same time, your immune system is developing memories of the vaccine, in the form of what we call memory cells. And then you have sort of this honeymoon period where you have these high antibody levels, you’re developing this memory, but then your antibody levels will go down, that is actually normal. And then the next time you encounter that virus, your memory cells are still there, though, and so they’re poised and ready to rev up and make antibodies again. So I think people haven’t fully understood how vaccines work, how they protect, they’re not perfect against preventing all infection, and there is a lag time for your memory cells to kick in and produce antibodies again, but they will produce antibodies, and they will protect you against severe disease, in particular disease in your lungs and your other internal organs. And that’s really what lands you in the hospital.

Andy Slavitt 

Okay, so now that we know that, if that’s what we knew from the start, we’d be like, no, I don’t want to take this vaccine, or would it be like, wow, that’s pretty great.

Dr. Celine Gounder 

I mean, to me, something that prevents you from landing in the hospital and prevents you from dying. That sounds pretty great.

Andy Slavitt 

Okay, so let’s just move on, right?

Dr. Celine Gounder

100%, let’s move on.

Andy Slavitt 

Let’s just move on. Here’s another one, we thought that you should give these vaccines two weeks apart, or three weeks apart, because we really wanted to stop people from dying, 5000 people a day dying almost at one time. And so we’re like, let’s give people a large amount. We don’t know, we don’t have time to test, we didn’t have time to run intervals. If we were in a six-month interval, we’d still be in clinical trials. Okay, now we know that a longer time in between the vaccines a longer interval is better. So should we cry about it? Or should we just move on? What do you think?

Dr. Celine Gounder 

You know, I think this is actually something we knew even before a typical sort of standard vaccine dosing regimen is you give a dose, second dose, you give it say two to three months. Third dose, you give it six months, and a three-dose regimen is standard, spaced across six months. But yeah, it would have taken that much longer to do clinical trials and get this out to people if we had gone with a standard regimen. And so that’s why Pfizer and Moderna went with these compressed regimens, why Johnson and Johnson went with a one dose regimen, it was really to try to get something that was safe and effective, but as quickly as possible into people’s arms and to try to make an impact on transmission as quickly as we could.

Andy Slavitt  14:37

So will you say it with me? Let’s move on people.

Dr. Celine Gounder 

Let’s move on people.

Andy Slavitt 

Let’s move on people. And you know why? You know why we should move on because we can, because 660,000 people can’t. And somehow we made it here and now we know different things. And so spending a whole lot of time wallowing in what Tony Fauci said in February of 2020, about masks? Is that the most productive use of our energy?

Dr. Celine Gounder 

Well, you know, I do think it’s important to learn from your mistakes. But at the same time, the operative word here is learned. And so learn means you change, you adapt, and you move forward.

Andy Slavitt 

Let’s talk about two different like what I think of as two different types of mistakes. Now, you had a leadership role in the transition team for the Biden administration, you obviously have had a podcast going back to the beginning of the pandemic called Epidemic, it’s a great podcast, with other podcasts too, which I haven’t been invited on. So I don’t really know how good it is. And so, you have this year of Trump. And now we have, you know, 6, 7, 8, 9 months of President Biden. Now I want to try to make a distinction. And you tell me, if you see this distinction, or I’m just being a partisan hack like everybody else, I think there are two types of mistakes that we make. They’re the mistakes that probably 90% to 95% of mistakes that you made, which are people trying their best learning, making very difficult decisions. I look around the country at governors, whether it’s in Ohio, West Virginia, Illinois, Minnesota, New York, California, nobody’s done it perfectly.

Andy Slavitt  16:52

But every mistake they’ve made has been a very serious leader with a very serious team, trying hard to make the best decisions they can for the population, not always getting it right, trying to balance business opening versus vaccine, we haven’t always been happy with them. But they’ve tried, then there’s another type of mistake, which is I’ll just call it a bad faith mistake. And we’ve seen some of them, and I’ve seen you comment on some of them. And I don’t know about you, but I’m less forgiving, okay, I’m very forgiving of people who like, did the best they could and are feeling the pain of these losses. But then you go to, I don’t know, Florida, South Dakota, the White House circuit, February 2020. And I say, these were people that weren’t even acting with our best interests, they were telling us the truth. They’ve been minimizing things. So talk to me about how much you see that talk to me whether you agree with that.

Dr. Celine Gounder 

I do agree with that. I think in particular; the CDC has really been attacked by all sides. And a lot of that attack has been related to communication. But honestly, it is impossible to get this stuff 100% right in a pandemic, there are just so many different factors interest that you have to balance as you’re also building the plane and flying it learning as you go. And so I think we have to be a little bit more forgiving of those kinds of mistakes, I think where people really do need to be held accountable is when they don’t tell the truth. I think that is the worst sin possible in a situation like this, where they’re not transparent. I think transparency, even if in the short term, it’s bad news, and people are upset about it. I think in the long run, transparency is what builds trust. And you can’t really get the buy in you need for all the things you need to do in a pandemic, without that trust. So I think those are major, major problems that we did see with the last administration. I think another is just conspiracy thinking, you know, those kinds of issues. You know, I think that has really muddied the waters here and has made it frankly that much harder for people who are trying to communicate responsibly, to get their message across.

Andy Slavitt 

Right, because there’s a lot of gotcha. And I noticed this other weird phenomenon where like, people will criticize somebody for saying something like, oh, well, the anti vaxxers are gonna use that as ammunition. Right? It’s like, well, you know, the vaccines aren’t perfect. Oh, great. Now you’re going to, you gave the anti vaxxers all of this. And, you know, it’s like, you know what, I got to tell the truth, I’m gonna be responsible the, irresponsible people are always going to do that. There’s always gonna be someone out there that’s going to distort things. So to my mind. I don’t know. I think there’s a risk of overly catering to people who just don’t have good faith.

Dr. Celine Gounder 

Yeah. And I think I think that second guessing of yourself of how is this going to be taken by people? How are people going to spin this? I think that second guessing is what really leads people to go wrong in their communication. I think you sort of have to put that on the back burner and say, you know what, I’m just going to tell the truth. Be straight up about it, be clear about it. And you know, let the anti vaxxers and whoever do what they’re gonna do, cuz they’re gonna do it anyway. Yeah.

Andy Slavitt  20:17

So when you were planning, the Biden transition, and you were anticipating issues, and you were thinking about what would need to get done. Now to remind people, we were in a hella bad spot. We were in a very bad spot last October, November, December, unclear what the outlook was, etc. What did you think were the priorities to plan for? And how do they match up to reality?

Dr. Celine Gounder

Well, there are sort of, I would say, two different kinds of priorities. One was around just getting stuff done. So how do you make sure you have enough vaccine supply? How do you make sure we have plans to get vaccinations and arms, I think you were very instrumental in getting all of that actual work done. So that’s sort of one side of things. And then the other side was really around communication. And we had anticipated a lot of the problems we were going to be facing around misinformation around disinformation. And I think, in some ways, we may have fallen a little bit short in terms of not being as aggressive in getting ahead of that as we could have been, I think the administration is now really stepping up to places like Facebook much more significantly, going after the disinformation dozen, which are the dozen or so people on Facebook who are responsible for creating over 65% of the disinformation you find on that platform. And then that gets, you know, amplified by other people, but they’re the route of 65% of that disinformation, I think, these are things we knew, but weren’t as aggressive about upfront, you know. And so it was sort of both buckets of things that we were talking about.

Andy Slavitt  22:02

The more you learn about Facebook, I’d say for me and I’d say this only but a very small minority of people we dealt with, but the more you deal with them, the more you learn about them, the more cynical, it all feels. The consequences are real. You know, when Facebook was about, like, Mark Zuckerberg picking out who thought the most attractive co-ed was, it was like ridiculous, but like people weren’t dying, elections weren’t getting stolen, or lost or whatever. The Russians weren’t manipulating us. It’s a very good point that you bake. So how do you think the administration’s done and one of the things I’ve really always really appreciated about you and like about you is, you’re not political hack you helped out. But you called, like, you see it when we were the administration and we’re doing things. If that was good, you let us know, if you didn’t think it was good, you were public about that, too. So I always felt like you gave an honest read.

Dr. Celine Gounder 

Yeah, I tried to be non-partisan about these things. I think you’re most effective as a public health leader, as a clinician when you’re non-partisan. And so that’s really what I lead with first.

Andy Slavitt 

That’s crazy. That’s so un-American of you.

Dr. Celine Gounder 

You know, that’s just my mindset is the mindset of the […]

Andy Slavitt 

Come on, get some controversy here.

Dr. Celine Gounder 

But, you know, I think vaccine rollout was awesome. And I really have to give you kudos on that, Andy, because you were really at the center of that. I mean, incredible. I think where we hit a wall really has to do with partisanship, polarization, politicization of vaccine rollout, and that intersecting with disinformation. And that, unfortunately, has become a rather difficult problem. I won’t go so far as to say intractable problem. And I think this is where the mandates are starting to have an impact. As with some of those folks, I was actually really encouraged to see I think Ben Wakana out of the White House tweeted the other day, some of the stats on how much vaccination rates had gone up in certain companies as a result of mandates. And those were significant. I couldn’t quote those off the top of my head, but those were significant jumps. And so I think, you know, those are going to kick in and help us get out of this plateau.

Dr. Celine Gounder  24:27

I think that was a tremendous success. I think there’s still room on the equity front, we’re still seeing inequities in terms of reaching Black and Brown communities in reaching rural communities. But I think vaccination big picture, especially in the first few months went really well. I think, in terms of where we have room for improvement. And this isn’t necessarily a Biden administration issue. I think this is a we have neglected public health for decades and decades. Is things like workforce, our information text systems, you know, you shouldn’t be having to fax data and then transcribe that into an Excel spreadsheet and then upload that. I mean, that’s crazy. And that’s sort of the level at which a lot of public health departments function. Our laboratory systems really also  need some work. And then having really valuing our public health workers, having adequate numbers of people working in public health, having adequate training and really appropriate salaries so that you retain good people. I think these are things that we need to work on and would make a huge difference if we can make those investments for the long term.

Andy Slavitt 

Right. Okay. We pick a couple things that you said start with mandates. Mandates are a horrible idea. I mean, would we ever mandate a vaccine for measles? Never. I mean, that would never wait a minute. Wait a minute. Okay, so would we ever require vaccinations for people to go to school? That would be wait a minute, we’ve done that. Wait, wait a minute, why? Why are they so controversial? I know there’s a reason. I know there’s a reason why they’re controversial. Well, I don’t know. I can’t think of it right now. But I’m sure it’s a bad idea to ask people to get vaccinated to be around other people. It just feels like you know what it is, it’s the freedom thing again, that’s what it is, it’s the freedom thing, they’re gonna steal your freedom. The next thing they’re going to do is to, Celine, I’m just warning you, they’re gonna come in your house, they’re going to take your guns, they’re gonna steal your pocket constitution, and you won’t be able to look stuff up in your pocket constitution, because they’re just gonna take it.

Dr. Celine Gounder  26:46

Well, if you’re afraid of somebody stealing, I’d be more afraid of Facebook, honestly. But that said, you know, there’s a really interesting history about anti vax movements that dates back to the 1800s. This goes back to like the days of smallpox, and you had people who would say, oh, my gosh, if you get the smallpox vaccine, you’re going to turn into a cow. Because the smallpox vaccine is based on cow pox. You know, there are bizarre kinds of theories that go back to that point in time.

Andy Slavitt 

Was it true? Did it turn out to be true? Okay, all right. Could have been, you know, people play with these doubts. It’s like, I don’t know, if that were today, there’d be someone on Instagram mooing and going say, look, I can’t control myself. I’m moving me there said did you see that Instagram thing of this woman who, like had these terrible shakes, and she’s like, shaking her whole body. And then she had like a talent when she was done. She was holding the phone and be like, I can’t control myself. And then when she went to turn it off, like at the shaking, stop.

Dr. Celine Gounder 

I did not see that one. I saw the people on social media who are pretending the vaccines have made them magnetic. Have shown paper clips sticking all over their face in arm. So yeah, it’s really crazy.

Andy Slavitt  28:08

Yes, but that’s why you take the horse thing instead. So you don’t have to deal with that.

Dr. Celine Gounder 

Yeah, ivermectin. Yeah, yeah, horse paste. Good stuff there.

Andy Slavitt 

So the second point you made and I’m, I’m only making light of these things, because I’m kind of an idiot, but I’m not really making light of them. I’m just having fun talking to you about this stuff. But you made another serious point to which was about the workforce, public health workforce. And it’s interesting, like, part of me feels like Congress. And what we do to invest under invest is a reflection of what we the people want and our culture. And like, it’s interesting, I was with my awesome DC the other day, who’s going to become a freshman in college. And, you know, she’s been home for the last year and a half. This is like, the really important period of her life. And it’s like, what do you want to study in school? And she’s like, oh, I want to go into public health. And, you know, I asked her if that’s true among her friends, and it’s like, it’s our thing. Now people are like, it makes me think about it.

Andy Slavitt 

Like, what this is the people and if you’ve got a caring individual, like my niece is wonderful. And you’ve got someone who’s smart and who likes challenges, who likes data, who likes health, but doesn’t actually want to be a doctor because, you know, that’s not for necessarily for everybody. Like it’s an amazing career. It’s a career where you’re Helping people, but you’re also solving problems. And like, I think, for this generation coming up who I think are caring, giving people by and large, I think that there’s a cultural attraction that we could see, I hope we see towards this kind of profession. And I have this view that we could be waking up in a few years now. And there could be chief Public Health Officers, inside companies, inside, you know, our government, and it’d be a bigger role and a prestigious kind of role, much like Homeland Security became a thing. What do you think?

Dr. Celine Gounder 

Yeah, I mean, I come from a generation. So I graduated college in the 90s. And, you know, at that time, HIV was a huge problem, well much of the world, but especially in Sub Saharan Africa. So I was sort of the generation that went into infectious disease, Global Health inspired by that pandemic. And I certainly think this current generation will be similarly inspired to go into public health, I think the key is, how do you retain them, particularly as the problems change? You know, so HIV is not the same problem today than it was in the 90s. And so you have to be able to retain those people, help them adapt to new opportunities, so that you don’t have these surges and interest in staffing and funding that then wane over time.

Andy Slavitt 

Right. Someone asked me what public health is, I tell him, it’s the reason you’re here. We would not be here. If there weren’t people along the way, making sure we had clean water to drink, making sure that what things were pollutants, that we recognize them and regulated them. And now all that stuff’s coming expensive our freedom again, of course, we have no freedom. But we have public health, and it’s we’re living in this torturous country without any freedoms. I mean, for years, like, I mean, so I’m, I’m older than you, I came of age. Like, I remember when seatbelts were recommended. And the protests were like, huge, like, this is going to increase the cost of the car. This is going to make buying a car impossible. This is going to, you know, be huge liability. Put a seatbelt doesn’t work, can’t do it. And then there was this whole like freedom thing, like someone’s gonna tell me what to do. Now that passed. And you know, you can make the argument and I would agree with that, that putting something in your body is a bigger thing than putting a belt across your lap, fine. I mean, there’s no perfect analogies.

Andy Slavitt  32:38

What’s interesting about the way the seatbelt thing played out, is it wasn’t just, it didn’t end up being just about the seatbelt. It ended up creating a culture of safety. It ended up spawning things around movements around against Drunk Driving, and ended up spawning airbags ended up spawning speed limits and end up spawning a whole bunch of things, which made road travel safer. I mean, when I was a kid, we used to like hop in the station wagon lie down in the back, you know, they’d be kids jumping up down in the front seat of the car, it was like seven years old without a seatbelt. And today, like you just we’re just conscious of it. So what I’m trying to say is like the culture that develops around public health will lead us many interesting directions. And it won’t just be the linear thing that we’re focused on now. But we will if there’s a consciousness where people say, hey, wait a minute, we can do things that enhance our lives, that allow more people who live in poor communities who live in areas that are forgotten, that live in areas that are getting affected by drought, that are living in areas that are getting affected by climate, that are living in communities that have drinking water that’s undrinkable. Like when you start to see those problems, I mean, see them and see their impact on people. And people start moving into those careers. Like that to me is when it gets unstoppable. Like to me in the short term, it’s about like, can you pass a law to help Flint? Can you pass a law to get money for the pandemic, but we need a cultural change for things to really stick in this country. Like they did an auto and you know, maybe this pandemic in the sixth generation will take us there.

Dr. Celine Gounder  34:16

Yeah, I think you’re making a really important point. I think this is a cultural change, a cultural shift in mindset, from freedom to do something as opposed to freedom from something and you need a balance between the two, I think we’ve been very focused on freedom, to freedom to bear arms, you know, freedom to speak as you want or gather as you want. As opposed to freedom from, I would say freedom from fear, freedom from sickness and death. Those are really important freedoms as well. And so I think public health can be part of reframing some of that, I think also, public health is public and we seem to have a real fear of things, public, of things shared, of things that are for communities, by communities.

Andy Slavitt

By we, you mean the US and the US particular?

Dr. Celine Gounder

I think the US in particular. And so I think that’s a major problem that we, I hope can reframe. And then I think also, we really don’t seem to get prevention, which I think is a bit bizarre, because if you would think, you know, we’re into individual responsibility, we’re in a fiscal responsibility, we’re into impact. All of those things would mean that prevention should be more highly valued. And you know, this gets at what’s happening in Florida right now, oh, we don’t want vaccinations, we want monoclonal antibodies, which are cost, you know, like 100 times more than a vaccine. And it’s sort of like saying, well, we have ICU. So it’s okay to get into a car crash, because we can put you back together? Well, maybe. Maybe not, you know, I don’t know if I would rely on that. Prevention is definitely the way to go.

Andy Slavitt  36:04

Yeah, monoclonal antibodies are great. I mean, chemotherapy and radiation, fine, too. But you know, what, when I’m grateful that when someone of my family has cancer, that was got stage one, and they didn’t need chemotherapy. And I was glad that chemotherapy exists, and even more glad not to need it. So I’m grateful monoclonals exist. I know they’ve helped number of people. But like, it’s like, just because they’re there doesn’t mean we have to use them people. Like, let’s give everybody a break, you know, no nurses, like, oh, please come in. So I can infuse you or inject you or ventilate, you, no, let them, let them just have some peace of mind, let you and let your whole hospital have some peace of mind. And I want to just sort of interesting to close on this idea that you proposed about, like, why is it that as a whole, we seem reluctant to want to do things for the common good. Oftentimes, culturally, there is certainly a me before the we, I get that, I want to make sure my own family is protected before I worry about others. But then there’s this like, once, I’m okay. You know what, I really not as worried anymore.

Andy Slavitt 

And so, kind of, you know, I don’t want, we shouldn’t think bad on anybody. But then again, I’m not gonna go out of my way. And in my view, and I’ve tried to propose, it’s like, if we all had a small inconvenience, if we all took a small inconvenience, think of it as whatever you want, wearing a mask, taking a rapid test before you enter somewhere, showing someone your vaccination card, yes, those things are inconvenient. Yes, they add minutes to a very busy day that you wouldn’t have had to do otherwise. Okay, but we have a pandemic, okay, sorry to tell you that the pandemic is gonna cause some minor inconveniences. But if we were all willing to inconvenience ourselves a little bit, and everybody would benefit. Why don’t we get that? Why don’t we understand that?

Dr. Celine Gounder  38:12

Yeah, I think we have this very zero-sum game kind of thinking in this country where if I, if I am making a sacrifice, it’s not actually going to benefit me, it’s only going to cost me and I think we need to sort of reframe things of if I sacrifice on behalf of my community that’s actually going to pay off, others will do the same. And because I am part of that community, I will benefit and especially with something like a pandemic, you know, we need to be thinking about the host, as all people, not an individual, and the virus is spreading through that host. And so you need to be thinking about it at sort of that meta level. That’s how you really deal with something like this, it would be like saying, I’m going to deal with climate change by building a bunker in my backyard, and we’re just going to go hide out in the bunker. I mean, that’s not a practical real solution. You know, this is something we’re going to have to band together and do together. And how do we get to that sort of more we thinking, I think it’s gonna be a challenge for Americans, but I hope and I think we can do it.

Andy Slavitt 

Now we’ve seen them happen before. But look, let’s just play into the selfish thing for a second. Or the self-interest. Does it feel better? Like just at the level of you close your eyes and remember what it feels like? Does it feel better when you do something generous for somebody and look out for others? Or does it feel better? When you do something for yourself? Like what actually makes you feel good inside?

Dr. Celine Gounder

I think it depends on whether you trust, if you trust other people and you trust them to do the same. I think when you do something for other people that feels better than if you don’t trust that they will do the same and then you feel like you’ve been cheated or that you’re, you know, sort of being taken advantage of. And I think that’s sort of the fundamental problem is how do we get to trusting?

Andy Slavitt  40:08

That is a boom insight, that is a powerful insight. You’re so right. You’re so right. If you feel like I just did a generous thing for somebody, but they wouldn’t do it back for me. So I’m just gonna think about, but then you get into this vicious cycle of, then I’m just gonna, no one’s gonna else gonna do for me, so I’m gonna do for me. Whereas if you feel like you know what, I’m going to start a chain of goodness, pay it forward or whatever, and have faith that it’s going to come back to me, then we’re better off. You just solved it. You just figured it out. I think you’re 100%.

Dr. Celine Gounder

Yeah, the question is how to make it happen. That’s the challenge. Well, that’s our next episode.

Andy Slavitt 

That’s our next episode. Making it happen. I’ll tell you how to make it happen. Let’s move on, people just move on. Move on. […] yourself, in the 18 months of the pandemic that you hated, pretend like things started today, and get some fresh wings. And I love what you said, Just trust. Just now the people this show, I’m preaching to the choir, and listen to the show. But just trust you do something good for other people, it will come back to you. And it just feels better. Like I think the feeling of being selfish feels okay for a limited amount of time, until you stop being selfish to do something truly generous. And then that feels amazing. It just feels amazing. I mean, I mean talking about a small thing, not like you know, giving away all your money. But just doing a small thing for somebody and seeing somebody else benefited knowing that they’re benefiting. It’s the best feeling in the world. I mean it is, it just subjectively is and if you don’t agree with that, then you shouldn’t be listening to this show. No, kidding. I think it’s a good feeling. What do I know? Well, you’re awesome. It’s been so much fun to talk to you.

Andy Slavitt 

This is fun. Great to be here, Andy.

Andy Slavitt  42:12

Okay, really quick. Thank you to Celine. Coming up, Ashish Jha, Ask Me Anything with Dr. Lisa. And Larry Brilliant. Enjoy. We will talk to you again Wednesday.

CREDITS

Thanks for listening to IN THE BUBBLE. Hope you rate us highly. We’re a production of Lemonada Media. Kryssy Pease and Alex McOwen produced the show. Our mix is by Ivan Kuraev. Jessica Cordova Kramer and Stephanie Wittels Wachs still rule our lives and executive produced the show. And our theme was composed by Dan Molad and Oliver Hill, and additional music by Ivan Kuraev. You can find out more about our show on social media at @LemonadaMedia. And you can find me at @ASlavitt on Twitter or at @AndySlavitt on Instagram. If you like what you heard today, most importantly, please tell your friends to come listen and please stay safe, share some joy and we will get through this together.

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