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The New Yorker Radio Hour
The Pandemic at Three: Who Got it Right?
00:19:05
As the COVID-19 pandemic approaches its fourth year, we can begin to gain some clarity on which countries, and which U.S. states, had the best outcomes over time. In a conversation with David Remnick, Dhruv Khullar, a contributing writer and a practicing physician in New York, explains some of the key factors. Robust testing was key for public-health authorities to make good decisions, unsurprisingly. What also seems clear from a distance, Khullar says, is that social cohesion was a decisive underlying condition. This helps explain why the United States did poorly in its pandemic response, despite a technologically advanced health-care system. Peer pressure, in other words, trumped mandates. Khullar also speaks to Dr. Rochelle Walensky, the head of the Centers for Disease Control and Prevention, about how misinformation and political polarization inhibit our country’s efforts on public health.
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Host/Producer
This is the New Yorker Radio Hour, a co production of WNYC studios and the New Yorker.
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David Remnick
Welcome to the New Yorker Radio Hour. I'm David Remnick. One weekday morning, just about three years ago, our team on the Radio Hour and all of the New Yorker staff got an email right as we were heading to work, and it said, turn around and go home. The lockdown had begun. The pandemic reshaped all of our lives, and many did not survive it. Well over a million people in the United States have died, around 7 million globally, according to the World Health Organization. The pandemic has eased considerably, but it is by no means over. And we have yet to assess the consequences for long term health, mental health, education, politics, so many things. Dhruv Kullar began writing for the New Yorker during the pandemic's most terrifying days, describing his experience as a physician in a New York City hospital. He spoke recently with senior public health officials, including the head of the cdc, about what we know now. Drew, it's almost three years since the pandemic began, and it's time to assess what worked, what didn't, who got it right, who got it wrong. So can you tell from here and now what countries got the pandemic response right?
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Dhruv Kullar
Yeah, I mean, it's a great question and an incredibly important question. And, you know, there's a number of caveats I think we should have up front. One is, you know, we don't have reliable data from every country. And so if you think about China, even today, you know, estimates say that in the last two months, they've probably lost one to one and a half million lives. And the official count is somewhere in the tens of thousands. The other thing to note is that the response and who got it right changes over time. And so if you look at a snapshot from a year ago, it might look different from today. But I think, you know, three years into the pandemic, I think we can draw some conclusions. And I think the countries that got things right, the ones that, you know, spring to mind are many of the East Asian countries. So Japan, South Korea, Singapore, Taiwan. There's also countries like New Zealand, Australia that did very well. And then you have maybe Denmark and Norway. And I think it really comes down to a few principal factors. So the first thing is you have to know where the virus is. The countries that were able to test early, have a test and trace program in place and have reliable reporting of that data, they were able to make mitigate the initial surges and along the way, make sure that when a surge did come about, they were able to respond quickly. So I think the first thing is you gotta know where the virus is and how to track it. The second one, I think, is something that's really been overlooked but incredibly important, and that's this idea of trust. I think both interpersonal trust, but also trust in institutions. That is something I think no one will be surprised to hear that the US Is tremendously lacking in right now. But if you look at some countries, like Japan or South Korea, you know, Japan's constitution actually makes it very difficult for it to implement the types of mandates that we even see in the United States. Lockdowns are kind of out of the question because of Japan's constitution, and they rely really on peer pressure. Another way to think about that is social cohesion, social trust. You know, masks became known as, you know, face underpants. Like, you wouldn't want to be in public without, you know, without your underpants on. You wouldn't want to be in public without your mask on.
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David Remnick
So you're saying that social cohesion may be a lot more important than mandates and even work better than mandates. That doesn't really bode well for us, does it? Did other places try to forego mandates? Did they turn out to be effective?
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Dhruv Kullar
You know, there are other countries, you know, early on, the United Kingdom, Sweden, that took a much more laissez faire approach to the pandemic, and they did not fare well during the early phase of the pandemic and actually pivoted to. To a more kind of mainline response in which they did rely on some of these things. The question of mandates is a really complicated one. On the one hand, vaccine mandates, for instance, seem to work. More people do get vaccinated when you mandate it. It also has a lot of downstream social and economic consequences. I mean, some people lose their jobs because of it. Trust in public health institutions may go down. It may be more difficult to address the next pandemic. And then, you know, with masks, the issue is even more kind of challenging. Whether you wear a mask and how well you wear a mask and what type of mask you wear actually makes a huge difference. The kind of willingness to properly adhere to a mask, mandate or mask encouragement is actually more important than the mandate itself.
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David Remnick
Mandates seem to have encouraged political division here in the US Blue states typically favored mandates along with more stringent lockdown measures. And conservative leaders tended to focus more on the health of businesses and keeping kids in school. What can we say now about the success of those various approaches?
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Dhruv Kullar
You Know what states were most successful? Depends on the metric that you're going to use to define success. In part, it might be helpful or might be instructive to look at two different reports that came out in recent months. You know, one is from the Commonwealth Fund. It's a prestigious, well respected healthcare philanthropy. It ranks Hawaii as number one. It ranks Massachusetts as number two. Places that few people would dispute that they had low death rates and they have an excellent public health system.
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David Remnick
Those are the bluest of the blue states. Hawaii has a certain geographical advantage.
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Dhruv Kullar
I think there's a couple interesting wrinkles here. So one is that Utah also ranked very highly.
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David Remnick
Not a blue state.
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Dhruv Kullar
Not a blue state at all. And then if you look at other studies now there's a big study from a more conservative leaning group of researchers from places like, you know, the Heritage foundation and the University of Chicago. What they try to do is put COVID death rates in a broader context. So they've said, look, we're gonna take COVID death rates, we're gonna adjust them for things like obesity and diabetes. We're gonna introduce economic factors. So how much did your GDP shrink or grow during the pandemic? What, what was your unemployment over that time? And then importantly, we're also going to look at education. In their analysis, Hawaii drops down to something like 40. And so the reason for that is, as you said, Hawaii is an island. It has certain geographic advantages, but its economy also took a hit because it's so reliant on tourism. A lot of students spend a lot of time out of the classroom in Hawaii. When they come up with their calculation, they again, they find Utah is the place that is the number one state, at least according to their analysis.
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David Remnick
Why Utah? What did Utah do that made it successful?
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Dhruv Kullar
But I think one of the most interesting things about Utah is, you know, we think of it as a red state, but it is actually kind of a unique red state. I mean, if you look at the current governor, for instance, Spencer Cox, he has described himself as a liberal Republican. I think a lot of their policies during the pandemic actually reflected that type of more moderate atmosphere. You know, I came across a survey a couple years ago that I thought kind of encapsulates some of this. The survey basically found that Utah was probably the best state in the country to lose your wallet in. The idea there is that there's a very high level of social trust in Utah. And other work from Oxford, for instance, has found that the countries that have the highest levels of social trust actually had some of the best pandemic responses. And we see that kind of in a microcosm here.
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David Remnick
What did we learn about schools? Opening them, closing them? What should we do next time?
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Dhruv Kullar
The main takeaway is schools should be the last thing that closed during any emergency, including a pandemic. And so overall, there was some risk of transmission in schools, but it was relatively low. There are states that had relatively short school closures, and they did quite well when it came to pandemic related outcomes. And so I think, you know, the school conversation is one that's so important because it affects so many lives and has a huge bearing on how students do in the short and the long term.
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David Remnick
But you got a lot of resistance from teachers and teachers unions.
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Dhruv Kullar
Yeah. And part of that is, you know, we didn't know as much as we do now. It's totally reasonable to, you know, in the moment Omicron hits, it's the most infectious thing that's come around, you know, in decades, if not more than a century, and to be alarmed and be concerned that a lot of that transmission may occur in schools. So that impulse is by no means something that I would dismiss. But now we have kind of the benefit of hindsight and we should think about it differently.
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David Remnick
Dhruv Kular writes for the New Yorker on public health. We're talking about the COVID 19 pandemic as it goes into year four. We'll continue in a moment. Ron DeSantis is going to run for president, almost surely. And beyond the issues that he hammers away in terms of cultural issues, he also hammers away at Covid and claims that he had a fantastically great record on Covid in the state of Florida. Is he right or is he wrong?
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Dhruv Kullar
The unsatisfying answer is that he's partially right and partially wrong. I mean, Florida is by no means an outlier in terms of a brilliant pandemic response. Neither is an outlier in terms of a horrific pandemic response. You know, they took a different tack from states like New York and California, but ended up in a similar state. If you look at things like deaths from COVID per capita or infection rates, you know, I think some of that is actually driven by the vaccination rates. I mean, Florida, as a state in the Southeast, actually has relatively high vaccination rates, and that's particularly true around older people.
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David Remnick
The US globally speaking, fared pretty badly in its response to the pandemic. We all remember the lack of preparedness, the lack of PPE and ventilators and more, and the really, I'm sorry, but the unhinged rhetoric of Donald Trump, we remember that all too well. The Centers for Disease Control came in for a lot of criticism, too. You spoke recently with Rochelle Walensky, who took over the CDC about a year into the pandemic.
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Dhruv Kullar
What are the kind of concrete steps that you feel CDC needs to take and is taking to transform its culture to be more effective in the next pandemic?
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Host/Producer
I came as a consumer to cdc, a consumer of CDC guidance, and that was sort of how I spent the first year of the pandemic and really have now taken this opportunity to do a full review. And among the things that we learned is we need to move our science faster. Not only are we clearing our papers faster, and we've decreased our average clearance time by about 50% since I got here, but we've also been releasing our data really in real time, so that people can really understand upon what data our guidelines are based. We need to have guidance that is implementable on the ground, sometimes with options for how to implement, because, in fact, it may work differently in Manhattan than it needs to work in Indian country. That our communication has to be more targeted in plain language to the American people. Because all of a sudden, people were coming to us where cdc, prior to the pandemic, was communicating largely with academic partners and with state health officer partners and public health partners. And so we at cdc, CDC have to be sure that we are delivering our information in digestible plain language because our audience has changed broadly.
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Dhruv Kullar
I want to get at the tension there. I mean, trust in public health is so incredibly important. And getting out ahead of your skis, so to speak, does that undermine trust in some ways if you get it wrong on the first pass?
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Host/Producer
I've published enough of my share of papers to know that you generally know the answer before the ink is dry on the publication. We need to find that sweet spot where we believe this is as good a data as we're going to have for some period of time, that it is as close to the right data as we are going to get in this moment. I can tell you from my vantage point, there is nothing more frustrating than needing to make an important decision knowing that the data exists. But I can't see it that I would make a better decision if I had more data at my fingertips upon which to make that decision. Right now, it's not well known, but CDC relies on voluntary reporting from these jurisdictions.
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Dhruv Kullar
Yeah. I do want to ask you about trust and about polarization as well. How do you contend with the fact that we are a deeply polarized society when you're also trying to be nonpartisan.
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Host/Producer
I have never walked at a patient's bedside and asked them how they voted before I delivered care. It is the case that this country right now is my patient sending scientific discussion, noble scientific discussion that is generally reserved for scientific meetings, plays out on the evening news and is consumed by audiences that don't necessarily understand the intricacies. And what they want is a unified voice and a unified message. And that has been one of the challenges of this time.
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Dhruv Kullar
But you have people with real power. I mean, Marjorie Taylor Greene now sits on the House committee that's investigating the COVID response, and she has spread vaccine misinformation. How are you thinking about contending with that type of thing?
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Host/Producer
Yeah, I mean, I think mis and disinformation is something that we're addressing here at cdc. I think it's larger than cdc. I think it's larger than the US Government. One of the things I will tell folks is sort of, these are the data that are out there. These are data that CDC has published, but importantly, these are data that have been peer reviewed in the New England Journal of Medicine in independent scientific review processes. And oftentimes, when people don't necessarily want to trust or don't feel as if they can trust a government source, I will send them to another independent source, a medical society or someplace else that is sometimes consistent, largely consistent, but not always 100% consistent with where our guidance is.
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Dhruv Kullar
Yeah, I want to ask a couple questions about vaccines and given kind of some of the backlash to vaccine mandates and mask mandates, you know, were in your mind, you know, mandates the right way to go? I mean, is that something that you would have implemented again in hindsight?
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Host/Producer
Hindsight's hard because you're operating with the data that you had at the time. If we rewind where we were at that period of time, I was working in a hospital that had a morgue, an extra morgue sitting outside the hospital.
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Dhruv Kullar
That I walked by.
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Host/Producer
And I know many New York healthcare workers were doing the same. So when you think about where you were at the time and what we were working to do incrementally to get more and more of society able to be opened. Those were extraordinary times, and they merited extraordinary measures for those times. We're in a different place right now. And so I think, you know, having conversations about mandates is. Is a different kind of conversation.
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David Remnick
Dhruv. I don't think we heard a very clear answer from Rochelle Walensky. Of the CDC about the political consequences of mandates or how to tackle vaccine misinformation. I mean, can we defeat a pandemic if people innately don't really trust the public health system and refuse vaccination?
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Dhruv Kullar
I don't think the CDC or really anyone has a clear sense of how to address those factors which play a huge role in our ability to respond to a crisis like COVID 19. You know, one of the people that I spoke to during this reporting was Zeke Emanuel. He's a really well known policy wonk. He was on the COVID 19 advisory board for Biden's transition team. He really emphasized to me that this sort of mistrust has a lot of serious downstream consequences and they go much beyond just how high your vaccination rate is.
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Zeke Emanuel
We are in a phase in American life. We attack experts and we pretend like we don't need them. And unfortunately, that is. It's a dangerous idea, especially in a more technical, technological, complex world. You need expertise. It's also dangerous at the bureaucracy level because people who are technically expert get attacked. And this is extremely, extremely dangerous for the country's ability to respond to future emergencies, but also just future normal operations. You need a lot of experts and a lot of expertise, whether it's demographics, it's modeling, it's vaccine evaluation and development. You just need lots of different people with different skills. You see it in the attacks on Tony Fauci. Here's a guy who's given 50 plus years of his life to the federal government. He could have easily left at any time for prestige positions, whether in academia or in industry, and he didn't. He kept working. I think if we keep attacking people like that, it's going to be hard to have civil servants who are going to want to work and be dedicated.
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David Remnick
That's Zeke Emanuel, an expert in public health policy, talking with the New Yorker's Dhruv Kullar. Dhruv is a physician at Weill Cornell Medical College here in New York City and you can read him on the pandemic and much more@newyorker.com this is the New Yorker Radio Hour. Thank you for joining us today and I hope you join us next time.
- [18:19]
Host/Producer
The New Yorker Radio Hour is a co production of WNYC Studios and the New Yorker. Our theme music was composed and performed by Meryl Garbes of Tune Yards with additional music by Louis Mitchell. This episode was produced by Max Balton, Breda Green, Adam Howard, Kalalea, David Krasnow, Jeffrey Masters, Louis Mitchell and n' Gofen M. Putabwele, with guidance from Emily Botin and assistance from Harrison Keithline and Meher Bhatia. The New Yorker Radio Hour is supported in part by the Tsarina Endowment Fund.