Tracking the COVID Third Wave (with Tom Inglesby)

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Andy calls up one of the country’s leading experts on pandemic preparedness, Johns Hopkins University’s Tom Inglesby, to get the best possible view on the winter wave hitting the country. Johns Hopkins has been the gold standard for COVID-19 information and Tom also has a prominent role on the Biden-Harris COVID transition team. They discuss why Andy thinks the next three months are the most dangerous time in the whole pandemic and offer tips on how to get through it — both as individuals and as a nation.

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Andy Slavitt, Reporter on TV, Dr. Tom Inglesby

Reporter on TV  00:01

As of yesterday, infections across the country topped 11 million. 1 million of those cases were recorded just this past week alone, including more than 156,000. On Saturday, it took just over two weeks for the US to go from 8 million cases to 9 million. That was at the end of October. And then it took only 10 days to go from 9 million to 10 million. Surgeon General Jerome Adams warned in a tweet yesterday that record cases over the past week will mean record hospitalization soon, adding that communities and hospitals cannot sustain high level care at this rate of increase. Right now the death toll from coast to coast is nearing 250,000 people in Minnesota Star Tribune yesterday, the obituary section took up 10 and a half pages of the newspaper.

Andy Slavitt  

Welcome IN THE BUBBLE. This is Andy Slavitt. You just heard a rundown of the current situation in the US right now. We are in what some people are calling the third wave of COVID-19 that’s hitting us across the entire country in the fall. And just to give a quick recap of what’s going on. Before we get to our guest, it’s probably the once again, we have somehow managed to land the ideal guest given the topic, given the moment, it’s Tom Inglesby from Johns Hopkins, who is the director of Center for Health Security there. And he’s going to give us a perspective on how we live through and deal with this third wave as a country. It’s a mixed story, the story of the pandemic is that it is everywhere. In one perspective, I think it’s no surprise, we have done very little relative to other parts of the world to stop that from happening. Some cases, it’s because certain people just haven’t been bothered and wanted to make an effort in some cases, you know, it’s actually quite hard. 


We’ve got people who are essential workers who despite their best efforts have been part of spreading this virus. Some part, it’s because it’s winter, and we’re all going indoors board. If you haven’t listened to our WINTER EPISODE from a week and a half ago, I would strongly encourage you to do that. And to pass that around. Because I know it certainly made me feel safer. It’s limited the kinds of things that I’ve wanted to do. But you know, where I’ll be getting to know people, or at least we are here at the Slavitt household who are getting COVID-19 and have absolutely no idea how they gotten it. They’ve been very, very safe. I urge you to not freak out. But I urge you to just be careful. And the reason I think you can be comfortable doing so is because we have a really good sense that there’s a light at the end of the tunnel. If you listened to our conversation with Eric Topol last week, a week ago, we talked about the coming vaccine from Pfizer, there are more on the way, including one from Moderna. And these looks like they’re going to be highly effective vaccines.


And so, you know, unless something goes wrong, in the first half of the year, things are going to begin to change for the better. But for now, I think great care is warranted, it can happen to anybody. So that’s kind of the message is that we have a very good piece of news, but it’s around a couple of corners, you know, we’re gonna have to turn a couple of corners to get there. And those corners are dangerous, more dangerous than we’d like them to be. So let me tell you about Tom and why we wanted him on the show. I think the Johns Hopkins for those of you who’ve been following this pandemic closely, has been sort of the shadow CDC, at the moment when the Centers for Disease Control has been politically compromised. Let’s call it a times. Hopkins has been just phenomenal. And Caitlin Rivers, who you’ve heard on our show before, is one of the epidemiologists there. 


Tom is the boss. He runs the center. He’s also professor at Hopkins School of Medicine. And he’s been an advisor to Governor Hogan there. And he’s on the Biden-Harris transition team. One more thing to note, and if for people who’ve come to this podcast more recently, if you’re annoyed by all of the ads, I want you to understand that if you don’t know that we donate 100% of the money that comes in to me from the ads, to COVID relief funds. So far we donated $50,000. So I really appreciate you listening and I really love all of our sponsors. We try to make sure that they’re relevant to you and interesting, but they’re also part of how we do that. So go back, listen to some old episodes. Get ready for Thanksgiving. Hopefully it’ll be a small one this year. And let’s ring up Tom Inglesby.

Dr. Tom Inglesby 

Hey there.

Andy Slavitt 

Hey Tom.

Dr. Tom Inglesby 

How are you all? 

Andy Slavitt 


Dr. Tom Inglesby 

Good to see you, sorry I’m late. 

Andy Slavitt 

Not a problem. 

Dr. Tom Inglesby 

And just in terms of timing is just three o’clock as an end time extends for you guys. If not before?

Andy Slavitt  

Yeah, three if not before.

Dr. Tom Inglesby 

Okay, for sure That sounds good. I turned into a pumpkin at three unless I call people ahead of time.

Andy Slavitt 

All right, we’ll get it, we’ll get it done. 

Dr. Tom Inglesby  


Andy Slavitt  

We’ll get it done. We made a little bit left foot; we’ll try to have some fun along the way. describe this third wave that the country is going through right now. How’s it different than what we’ve seen so far.

Dr. Tom Inglesby  

So what’s happening now around the country is a much more rapid rise in cases than we’ve seen at any point since this started. It’s much more distributed than it was in March or even in the summertime when it was really a number of states, but across the South and the West. Now it’s in the majority of states to varying degree, the rate of hospitalization rise is faster. And the number of people hospitalized is higher than we’ve ever experienced in this pandemic. And the number of people on ventilators is going up by 100 or 200 people a day, not we haven’t reached the same numbers of people ventilated as we had in March. But that’s in part because of better clinical management. And we’re less, we’re less likely to put it we’re more hesitant to get people on ventilators quickly because of the downside of that. 

Dr. Tom Inglesby  06:33

But overall I would, those things are all happening in a setting of many Governors making choices not to take steps not to take policy steps, which is again is very different from March when at least we started. I think the country started in a similar place we started kind of It was shocking and fast. But most places around the country, shut themselves down to try and get control. And we’re not seeing that at this point. So there’s no real ceiling that we can hope of once we hit this number, we know that we’re at the top and we’re going to start coming back down again, it all depends on what we all do. So it’s a very frightening rise. It’s very different.

Andy Slavitt 

To some extent, I’m sure you’re not at all surprised by what we’re seeing. And to some extent, there may be surprises in here. And I’m curious, we call some of these things out. I mean, you know, by and large, people are staying away from large crowds, large events, you know, some of the hotspot places like bars are certainly still open in some places. But there’s a bit there’s a higher awareness. Where do we think, and we hear now about small gatherings people’s homes, rural communities. Where do we think this is spreading now? And does this tell us something about how contagious this is that we didn’t know before? Or is this simply a matter of indoors, winter poor ventilation?

Dr. Tom Inglesby  08:08

It’s hard to tease the whole thing out which portion of the problem is attributed to what issue but we’re definitely seeing more incidents in within small gatherings and homes that’s been documented. But I think it’s still the case that we’re seeing spread in workplace environments, restaurants, bars, I think one place for people who are listening that one place of good information is the Louisiana Outbreak Reporting Dashboard. It’s just one example. There are other states that do it too. But if you look down it, and you kind of look at where social gatherings fall, it’s in there, but it’s still small compared to religious institutions, restaurants, bars, retail, I mean, there’s lots of places where spread has been documented. And so I think what I absolutely agree with the guidance that’s been given out about, it’s time to really limit our gatherings. 


And I would have those limits be as small as possible, less than 10. But avoid gatherings, bringing people together in the holiday, sadly. But it’s not just that. And I think we just need to make sure that we don’t only kind of move from one thing to the other. Indoor workplaces also are clearly a risk if there are lots of people together, and people breathing the same air if it’s poorly ventilated. So yeah, I think, you know, in terms of your question to you know what’s going on right now, why is it different? It is because people are moving indoors, most likely. Less outdoor events, more indoor events, more people have come back to work, indoor environments at work. More people are gathering and taking risks.

I think, you know, in many states up until a few weeks ago, if you look at the closures, many states were almost completely open, really almost no restrictions. It’s changed a lot in the last couple of weeks, which is really good. But if you put all these things together colder air, some people getting tired of what’s going on policies that aren’t very strong, very unclear messages from the national government and from state governments. I think it’s all contributed. And now it’s rising at an exponential rate, we have to take steps to stop it.

Andy Slavitt  10:23

Right. And I think that the implication of the last thing you said the exponential rate just means that it’s more places. So you know, if you went to the grocery store in May, or April, there may have been, if there were 40 people in there, there may have been one or two people in there in the last hour. Now, if you go, it could be dozens of people that have it. And so I think the chances just go up. So this is sort of a self-fulfilling prophecy. Let’s go back to talk about the rural communities in the hospitals for a second, because there are a confluence of factors I, you know, I talked with Mike Dewine, Governor of Ohio the other day, and he’s really perplexed because he said, Andy, I don’t know how to police, small gatherings, he has a mask mandate in Ohio, you know, he tries to use as the bully pulpit. And all it seems to do is anger people in the in the small towns, and yet small-town hospitals, you know, for people who don’t know, some of them have, you know, eight ICU beds, and a couple of ICU nurses. And for most of the time, that’s fine. But environments like this, you know, I’ve been calling around and I know you guys collect a lot of data on rural hospitals. And it feels like, we may be brewing for the I don’t know, the kind of crisis we see in developing countries.

Dr. Tom Inglesby  

Yeah, I mean, some of the data that we collect doesn’t really even get to the difficulties of the rural hospitals, because not just the absolute numbers that are going on. But it’s really what you said, which is that it’s the ratio of beds to a given part of the world, or given part of a city or community or state. And if there’s no real, if there’s a really minimal infrastructure, then it’s possible that community will not be able to be cared for in that hospital will have to be moved either hours away, or we just don’t have enough, you know, we could we could get to a point, I think it’s hard for people to imagine it. But we could get to a point where doctors and nurses just can’t keep up with the demand. 


We have many more ventilators now than we did in March that a lot of ventilators were made, which is a very good thing. But I think what we saw in New York City in March, was that we did get close to running out of ventilators in variety of hospitals. But what was happening, in addition was that many people who were sick enough to be on a ventilator were having to be cared for by doctors and nurses who never took care of ventilated patients. So you know, they’ve got a ventilator, but they didn’t get the care that they would in a normal American Hospital because they were overwhelmed. And that we’re on the edge of that happening. Now. I mean, that’s a different way. It’s a different form of the standards of care.

Andy Slavitt 

Very similar. I think I’ve seen some data. And I can’t recall exactly what it said, but the number of people who are dying in small rural hospitals versus large academic centers, your odds are much lower, unfortunately, in a rural hospital, where they just have less experience and all of medicine experience counts, and we’ve learned a great deal. One of the questions I think a lot of people like you and like myself have been focused on is what we’ll break through to the public any longer. And by the way, many of the Governors not all, some of them are bad actors have to say, but many of the governors are feeling this this pinch, pretty strongly. Not getting any federal support, but also trying to figure out how to how to break through. 

There was a doctor the other day, who said that he was saying here, people in rural patients who include people were on ventilators dying and denying that they had COVID and offended that the doctors were messed up around them, because they said I do not have COVID, COVID isn’t real. There’s certainly some of that, although I’d like to think that’s not the majority. But there’s everything between that and fatigue. And we’ve seen these death toll numbers rise so much that maybe people are getting more indifferent to them. And I’ve often felt that, you know, somehow we need to get cameras in the hospitals and it needs nurses faces because they are the best books people for what’s going on. In the sense of what works in breaking through. It’s obviously a question that the President-Elect likes to have to try to answer for himself as well.

Dr. Tom Inglesby  14:35

Yeah, I don’t I don’t know the answer to that. I think I’ve seen some social science research that says, really, sometimes, you know, when it’s the death of, you know, 20 people as versus you know, a 1000 it can be more compelling to people because they can see those 20 people and 1000 becomes overwhelming and a statistic and people lose track. So one thing that I’ve seen, I don’t know if it works or not, but I think It’s important just kind of to remember the individuals who are sick and dying in the hospital and those who’ve died. And so sharing the stories of people, just to make it make people see that it was a person who had a real normal life, or were sick or wasn’t sick or was younger was old. But it’s no longer here. I think those just reminding people that these are, you know, individuals, and these are not statistics. I don’t know if that will help. I think one thing that will break through in the worst way, is when people can’t get care in their own communities or become frightened to go to the hospitals. 

If they look at their hospital, which they’ve always relied on, and they see it as a place where they’re either going to get COVID, or doctors and nurses won’t be able to care for them, because they’re overwhelmed with COVID patients. That might be a moment where people call for something else. They start demanding something else, I think, people who aren’t necessarily believing the bad news about COVID. And are, you know, think it’s not real in some way. I do think there are people who speak to them, you know, they do have cultural leaders, political leaders, religious leaders. And I think if those leaders made a change, I think they would listen. But I think if sometimes, you know, it sounds like I saw something today, it said that a lot of the public health messaging really had not in any way impacted the election results, and that people who believe one thing stay in that direction and didn’t change. So obviously, we need to have, you know, all kinds of voices involved.

Andy Slavitt  16:44

That’s one of the things that you know, I think the Vice President or President-Elect that is, you know, we’ll clearly need to do is get, get all kinds of local voices in the community, talking people’s language and listening, and listening to people because I think, you know, the people who are not wearing masks, they’re saying something too what might need to be heard, before this dialog can really move through. 

Andy Slavitt 

And now, for something we like to call advertising.

Andy Slavitt

Let me ask you kind of this kind of philosophical, existential question. I think I know the answer to this, but I will go with your answer. We had a situation where we don’t know what to do. In other words, we don’t know how to slow down this wave and get things under control. It’s just beyond our knowledge and our ability set or option two, behind the curtain number two, we actually know what to do. We’re just having a hard time gathering the political, social, will, etc. to do those things.

Dr. Tom Inglesby  18:02

It’s number two. And I mean, there’s probably a little bit of one in this fence in the sense that we’ve never really been in this situation for modern times. But we have seen all along what’s been effective. We’ve actually tried it a couple times in the US, we’ve had a couple of peaks. And we’ve seen some kind of reactions. And we’ve seen what happens when those kind of reactions and new policies are put in place this epidemic, we are able to drive this epidemic down. We saw in Israel, not very long ago, they had a case that were out of control rises that were out of control. They put in what they called a national lockdown, but it really wasn’t what we experienced in March. I think that term lockdown is so loaded that I even hate to repeat it, I think we should be more specific in terms of the actions that people talk about. 

But they shut down large gatherings, and they limited smaller gatherings, places where people are spreading the disease. And within a couple of weeks, I think it may have been between two and a half weeks or so they started to see a dramatic decline in cases. So they were in the middle of kind of their own, you know, moment like we’re in, and they change course pretty quickly. But it took a national effort took a unified effort. And it was politically very unpopular, but it changed directions. It’s not doesn’t mean to say that they couldn’t be back where we are again and another month. But it’s not confusing what we need to do. It’s whether we can do it.

Andy Slavitt  

Yeah, I had Ed Yong on from the Atlantic and we had a fascinating conversation. And one of the things we talked about was he’s phenomenal, is you know, our kind of relative success and privilege as a sort of island nation with all kinds of resources and, and resulting lack of experience, most specifically experienced with a pandemic and highly infectious disease, but also, you know, that it spills over into some so it was you know, experience sacrifice. And experience going through difficult times, and so forth. Whereas, you know, to take give Democratic Republic of Congo, right? They’ve been through so many of these, that, you know, this is like slow-pitch, right? For some of the Central African countries, or certainly Hong Kong, where tremendous amount of traffic coming in from China, but they’ve been there done that. And I have often referred to this as our starter bug. Sadly, we are learning the hard way. But by God, I hope that, that we learn those lessons, how much do you think is, is that or, indeed do you think  there’s something else that’s at work here why we are so much worse at this?

Dr. Tom Inglesby  20:39

I mean, it’s just probably there are many reasons. But I think Ed’s definitely right that we are not used to these kinds of, you know, emerging infectious diseases rampaging around the country. We haven’t had to deal with we’ve had, you know, we saw what we  how we reacted with only a few Ebola cases, we didn’t react well with that, which is disease, that’s obviously much less concern about you know, in terms of spread. And I think we have a low tolerance for risk that on the one hand, you know, helped us or it kind of had a reaction in the in Ebola, which was over, you know, overreaction. But now I think we’ve become a kind of desensitized over time. And I think, compared to other parts of the world, we’ve just had, we’ve had less preparation. And unfortunately, I think the relationship between science and political leadership is very different in many parts of the world, it just for in this particular moment in time, there just has been too much of a rift between public health science and political leadership. And I think it’s just gotten us way off track. And I think there are many places in the world where that isn’t the case, just there’s much more partnership hand in glove. And this is more functional.

Andy Slavitt  22:04

That’s I think a pretty big nut to throw everything in the kitchen sink in, but a big divide in terms of race and income and job type. So to the extent that, you know, I’ve always believed that to some degree to the extent that lower incomes and bipod populations are more impacted, that as other people felt safer, they’ve been able to be less careful, because people like them, they don’t know a lot. They haven’t known a lot of people now that that may be changing now. But that certainly, our diversity and our inequality, I don’t think is our friend in a situation like this.

Dr. Tom Inglesby 

I completely agree. I agree. I feel like you’re definitely right, that essential workers who’ve been in the frontline, since the beginning of this who’ve been at highest risk, are disproportionately people of color. People who are at higher risk of severe disease, also, you know, backgrounds, we have less access to medical care. So I do think that parts of our society are higher risk of a severe outcome with COVID than others. And so I think it’s probably been a little harder for parts of our society to see how terrible it is up close and personal, and you can read about it, but they haven’t seen it or experienced it in a way that parts of America have.

Andy Slavitt 

Right. So let’s talk about kind of where we’re headed now. We were talking on the day that Moderna released a prelim preliminary data on its vaccine candidate, and that data was showed about a 94% efficacy rate. It’s on the heels of course, the Pfizer drug we have an episode with Eric Topol from last week where we were just as that came out. So this is probably less surprise. But certainly good news. As you think about what this tells us about A. how much we have left, what the future of this thing looks like, what it depends on and then, you know, B. how should that help us get through this next period of time, I would say that, you know, the next three months are going to be the most dangerous period of time we’re going to have in this virus. Sadly, it’s a period of time when there’s nobody running the store. Although you might argue that nobody’s been running the store for quite a while. But is that the case? Do we do we really have legitimate light at the end of this tunnel to look forward to?

Dr. Tom Inglesby  24:31

I mean we’re not quite there yet. But we’re close to saying we have light at the end of the tunnel. We have to see the actual data, but at least the public announcements from Pfizer and Moderna are very encouraging. I think they really exceeded in terms of efficacy of the vaccine exceeded a lot of expectations, considerably exceeded them in depth, 90% and 94%. That’s really impressive for a vaccine. The Moderna press release today says that their vaccine is well tolerated relatively low side effect profile, we’ll have to see, you know, when we actually see the data, but overall, what we’ve seen publicly released has been very, very encouraging. You’re absolutely right, though, that even in the vaccine, both of those vaccines one or one or both were authorized by, you know, a month from now, let’s say that would be pretty fast.

Let’s say it was a month from now. It’s still going to take a lot of time to get people vaccinated, you know, what Pfizer has said, is that they will be able to vaccinate 20 million people by the end of 2020. If they can do that, that’d be fantastic. But at 20 or 30 million people a month, which I think they said the rate might be 30 million a month, that’s still going to take us a while to get even to the highest risk Americans and Moderna on that, see, it starts to accelerate it. That’s good. But I think you’re right that in even the best-case scenario, it’s going to be number of months, probably three or four or five or ish, it depends on lots of things going right for us to get vaccinated.

Andy Slavitt  26:02

Right. But we’re talking about months. I mean, look, my grandmother lived through a 10-year depression. We live World War. They’re people that were, you know, sadly, enslaved for generations. And so I want to I just want to put our sacrifice in perspective, I know people aren’t going to are bummed out, they’re missing Thanksgiving, I hope you do. Take him a lot of precautions for Thanksgiving. But I hope people can start to feel like this isn’t going to last forever. That whether it’s three months, four months, six months, you know, and it’s not, it’s not into reminding people, it’s not simply your vaccine, it’s when enough vaccines have been given that this virus starts to find it very difficult to find a place to land. And can we be reasonably certain that over the course of 2021, we’re going to start to see that happened in a big way.

Dr. Tom Inglesby 

Very high confidence, at this point for not to happen, it would have to be surprises at the end of trials that we didn’t see coming at the public releases really are don’t support that. So I think it’s very likely that over 2021, probably in the first half of 2021, by summertime, a lot of America will have had a chance to be vaccinated. And as you say, You’re exactly right, that it doesn’t take all of America to get vaccinated if we can get 60%-70% of us vaccinated over that time period, that virus is going to slow down, slow way down. It doesn’t mean it’s gone. We’re gonna have to live with it in the background. But we won’t be doing any of these things anymore. We will have slowed. Somewhat it’ll it won’t be like an overnight like on March 1st, social distancing on March 2nd, we stop. But over time, it will become clear that it’s safer and safer and safer. We’ll be able to measure the percent positive test the incidence daily in a state right now in states across America, we’re seeing 40-50-60 more than 100 cases per day per hundred thousand people. CDC says, look, we really need to get to get in school safe again, we need to get down into single digits. vaccine will help us get there. But we need to do things in the meantime, before we have vaccine.

Andy Slavitt  28:09

Right. And we’ve talked about the Swiss Cheese approach and making sure that you take as many measures as possible. I think of it this way, because I’m big on trying to turn science into analogies because I was such a poor science student. But like right now, like we have the presumption of guilt. Here’s what I mean by that. If I ran into you in the street and you weren’t wearing a mask, I’d have to presume that you might have COVID-19. That’s just the safest thing for me to assume. Because we’ve got so much community prevalence, no offense to you, Tom. I’m guessing you’re careful. But you know, the general assumption is I’m going to presume you’re going to be guilty. We’re going to have we’re going to flip to when we get these things contained, and we are able to measure how much is it a community and we’ll be testing, we’ll be testing the water and the sewage water, we’ll be able to assume, presumed Innocent again, I mean, and we’ll be able to run into each other and say, the chances of you being sick, they’re not zero. But they’re so marginally low, that I don’t have to make that assumption. And I still may choose to take some precautions, we may culturally make changes, like not shaking hands as much or things of that nature. But it will be a whole different ballgame. That’s a tipping point. And I don’t know if you agree with that analogy or not. But I really want to presume you innocent.

Dr. Tom Inglesby  

Yeah, I like that. I mean, I really love the way of thinking about like that. And in addition to vaccine, as you say, we’re going to be testing in different ways. As more rapid testing becomes available, we’ll be able to start screening people out earlier and institutions, institutions will feel safer. Some universities are already doing that really well. So that the university bubble is pretty well protected and they can presume innocence with each other. They still wear masks, there’s still social distance, but in general, you know, they’re getting tested twice a week in many universities  and they’re doing pretty well with that.

Andy Slavitt  30:04

Don’t go anywhere, we’ve got to go earn some money to donate to charity.

Andy Slavitt  30:18

So let’s help people get through the next three months or so or since it’s going to be the confluence of winter travel, holidays, the largest amount of humanity spread we’re likely to face. You know, people who listen, I think are probably familiar with the traditional precautions. And we know a number of people who are very careful, because they’re friends of ours, and we know them. And there’s reasons for them to be careful who have now gotten COVID, who believe they’ve been careful, can’t trace back where they got it. I literally went through last night, someone who was in Obama’s cabinet, who has actually been in the show, Arne Duncan, who’s incredibly careful.  And he can’t for the life of him. Think of a thing that he did, where he would have been exposed. It’s a little frightening for people to think about, but it’s also not pulling any punches. It’s a warning that it can take one outing, I suppose. Or one, one event. So without driving people crazy and only talk about what’s possible, what advice should we give people for the next few months?

Dr. Tom Inglesby 

In general, I would, I would, I would avoid indoor spaces, just like you just said, unless you really need to be there. I think we all have; we all have a risk budget. If you think about your life, how many risks you’re willing to take anything could do it. But if you do 10 of those things, then you 10 times the risk. If you do 10 indoor meetings, then, you know, having one where you need to go, that’s one level but you know, thinking about it each time Do I really need to take the risk of being in this indoor space with other people. I think that really unfortunately, in most places in the country, not all but most places in the country at this point would include probably indoor restaurants and bars. I think I’m hopeful that we can find a way to compensate people whose businesses are really crushed by this, but I think it is going to be in many places, most places probably dangerous, or at high risk of transmission in restaurants and bars. 


And I think avoiding family gatherings. Unfortunately, when lots of people are brought together, sadly, I think for these holidays, hopefully these are the last two big holidays that families have to deal with this, you know, Christmas and or the December holidays, Christmas, Hanukkah holiday, and Thanksgiving. And then, you know, the usual things that we talked about avoiding rallies, physical distancing, you know, kind of things we’ve been talking about all along, there’s not a lot of surprises to it.

Andy Slavitt  32:47

So I’ve got this crazy idea that I’ve been talking to a few Governors about. And if you say it’s a real time, column bar bonds, so getting state municipalities, state that needs t to issue bonds, there would be general revenue bonds that public would buy. And it would pay kind of a standard interest rate. And we go really to paying not just bars, bars, restaurants, small businesses, gyms, etc. to stay closed, because, frankly, the federal government should have been doing this. And the US Senate has failed. I mean, let’s just be very blunt, we’re about to put out an iPad, which says that states can use the revenue raising authority, and it’s a little bit different in each state. And that if you bought these bonds, you would also get 15% discounts on these, and these bars, restaurants and establishments when they open as kind of a Thank you.

Dr. Tom Inglesby

It’s clever. No, I mean, because everybody’s talking about this kind of the lack of support for businesses that are going to be crushed, and the lack of federal movement on it. And so coming up with an idea of where a state could actually take its own action. I think that’s really clever. I don’t know enough about economics to know if it’ll actually work. But I love the idea of thinking of new ways to do it.

Andy Slavitt  34:02

Yeah, I know, we’ve got to be creative. We look, we address the war, we issue our bonds. I mean, you know, there we can be creative there ways to get through things. There’s no excuse for my opinion, and just say to my opinion, though, excuse for the for the federal for the Congress, not to have taken certain supportive actions, one of them is that the other of course, unemployment, but the third, and I know what you think about this, but paid family leave, like we are so I’ve talked to more people who have had to go back into the workplace symptoms are not doesn’t matter, because they just can’t afford to take care of their families. If they’re not working. And we can’t do that to people.

Dr. Tom Inglesby  

Yeah, I mean, that’s also when you’re talking about what’s difference between the US and many places in the world. I think many other highly developed countries have that in place. And so it’s really it’s a standout that we don’t, and that people could possibly be pressured to go to work when they got a fever during COVID or, you know, symptoms during COVID. Or, you know, it just makes no sense at all that but that’s where we are.

Andy Slavitt 

In fact, in my book, I have a couple of conversations with people who said you can only way you can get paid is if you have a positive COVID test in April when there were no test when there was no testing available. So they would call back and said, I can’t get an COVID test, or it’s my father that has it, and I’m in contact with him. And it feels a little symptomatic. Just sorry, without a COVID test, we can’t pay you. And so they went without pay. Because we didn’t have enough testing. I mean, there’s so many of those stories that we uncovered that are just things we’re doing wrong things we got to fix about ourselves. So you are, you are named to the Biden transition team. And I’m not gonna ask you to speak for the transition team. In fact, I think, next Monday in the show Vivek Murthy will be on who is part of the Biden Task Force. But let me just make a statement which you don’t need to respond to. 

We just thank God, you’re on that team. Thank God, you are in that position and others. But the number of quality people who understand this issue well, and you know, you’re that you’re at the top of that list, that are going to bring kind of the full weight and energy of your thinking, and your ability to act and the things you’ve done. Because  I think of what you guys have done at Hopkins, you know, you haven’t just simply been sitting back and opining, you’ve been out very assertively, learning things, telling the story, putting out papers, putting out thoughts, and filling some of the gaps we’ve had as a country. Thank you for doing this. Thank you for serving this way. I think it’s gonna be great to have you there.

Dr. Tom Inglesby  36:35

Oh, that’s so nice to say thank you so much. I, as you seen in the last, it’s incredible people, so I’m excited to do whatever I can.

Andy Slavitt 

And for those who want to make the tie, we’ve had on the show a couple of times Caitlin Rivers, who has been on our game show SAFE OR UNSAFE. She’s the all-time champion of that game. She’s so people if they like Caitlyn, then they get to know Tom, Tom, it’s not maybe to close up, you give us a little bit of a sense of the work you’re doing at Hopkins, a little bit about your Center and what you do there, and anything else you want to share?

Dr. Tom Inglesby 

Yeah. So our center got started by a guy named DA Henderson a way back. And he was the guy who ran the smallpox eradication program for the World Health Organization as a credible public health leader for the century. And he was worried about the country not really having systems in place people in place to deal with epidemics. So we started our center. And that’s what we do, we focus on trying to prevent, and then respond to and prepare for big epidemics. And we have people like their doctors, or epidemiologists like Caitlin, or former government officials are scientists, and we try and identify problems that are either not working or not surfaced, and figure out, you know, trying to contribute to their solutions. So in COVID, we’ve tried to kind of identify things that are coming, and then put a team around them go after that particular facet of a COVID problem. 


And then, if possible, try and develop either guidance or a new idea, or, or explain something that seems like it’s being garbled. And so we work in teams of people, we’d go after problems right now, we have a group of people trying to develop the best possible guidance around indoor ventilation, there’s a lot of technical guidance, but what is the average person supposed to do? What’s the you know? What’s the federal government’s role with that what federal policy would be useful to a number of really good people thinking about that talking to experts around the country trying to bring things together? We have another group working on vaccine safety issues. What’s the plan right now? What’s missing? What would policymakers like to know to try and to help patch the holes? So that’s the kind of work that we do during COVID. We got really incredible people.

Andy Slavitt 

How did you decide to play such a prominent role? And how did you decide on the things to take on because in some respects, and I don’t think this is exactly the right way to say it. But you became sort of a shadow CDC for a while, you were sort of become the definitive source for a lot of information that in normal periods, I think would have been sourced to the CDC or sourced to Hopkins. And certainly, when I was asked as a lot of as frequently, where should I go for information where is reliable. You know, my stock answer is, you know, find two or three places that give you two or three types of information, find places to disclose their biases, find places that are honest about what they know, and don’t know. And Hopkins, those.

Dr. Tom Inglesby 

Thank you. That’s very nice you said. Since we focus on these issues kind of day in day out, it was, you know, we were kind of paying attention to it, you know, at the beginning of January. And then they’re just a number of ideas came from the group about what we might take on what problems that we thought we could help solve, and we have a pretty good structure, so that we fundraise as a group, we kind of act as a as a pretty, you know, we’ve worked together for a long time. So it was not too hard for us to shift into gear, and work as a team to try and identify problems and go after them during COVID. And there’s nothing more compelling right now, obviously, nothing more important than try and get this figured out.

Andy Slavitt  40:22

Well, thank you for the role that you you’ve been playing, we’ll have links up to all the information that you guys put out on our show notes. Thank you also for the role that you’re playing now. And I’m sure the role that you’ll play in the future. And I think, particularly as we think through the lessons here, and how we, you know, we make ourselves a better country, because I don’t think building a better public health system is entirely just the answer to how we avoid this. Again, I think it’s some of the things about our country that we need to have real conversations about and move into. 

Dr. Tom Inglesby  

Well, thank you for let me just say thank you for doing everything you’ve been doing. I mean, you’ve been from the very beginning, you’ve been thinking about what people would need for contact tracing, you’ve been leading others to try and speak to, to our lawmakers. You’ve been a force in social media and communicating in this show I’ve been, I’ve been looking for my invite to the show to hang out with you for now. So thank you for having me. And thank you for doing this. I think it really speaks to people it really helps translate concepts to things that everybody can hear.

Andy Slavitt  

That’s great. Well, thank you for saying that.

Dr. Tom Inglesby

Really appreciate it.

Andy Slavitt  41:35

Thank you for listening in. Let me tell you what episodes are ahead because I think you’ll like the work we’ve got planned. Monday, we have an episode with the Chair of Biden’s Task Force on the transition. Vivek Murthy. Vivek is a former Surgeon General good friend of mine. He’s going to tell us how they’re approaching this transition. Great fun. Then we have a Thanksgiving episode. Surprise, you can play that. Well. You should have been otherwise been playing a big game with touch football, you can listen to our Thanksgiving episode, instead. And then following that we have a couple of I think very important episodes. One with Ashish Jha from Brown. You’ve seen Ashish all over the TV is one of the leading authorities on this pandemic. He’s great. And then an exciting Toolkit episode on vaccine distribution because it will be time to begin talking about how and where vaccines are to get distributed, where you can get yours, what to expect, how all that stuff’s gonna work. That’s it. Thanks for sticking with me. I hope you have a fantastic rest of the week. 


Thanks for listening 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. My son Zach Slavitt is emeritus co-host and onsite producer improved by the much better Lana Slavitt. my wife. 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, but still tell them at a distance or with a mask. And please stay safe, share some joy and we will get through this together. #stayhome

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