The Path Forward, with Surgeon General Jerome Adams
Suzanne Clark: What is the state of the coronavirus in the United States today?
Dr. Adams: I want people to understand the virus itself hasn't changed a lot, but our understanding of it has changed tremendously. If you think about our history in this country, the times of greatest innovation, particularly in the medical field, in scientific fields, have been during and after times of war, whether that's the civil war, the First World War or the Second World War.
And we've seen more advances in the last eight months than we've seen in the last decade in this country. We know much more about who is at risk and why, and that's resulted in us being able to better protect the vulnerable and significantly lower mortality rates among people who are diagnosed with the virus. We’re shortening hospital stays because we know much more about how to treat those who do come into the hospital.
We know what works to keep communities safe. My office has launched an aggressive campaign called #COVIDStopsWithMe. I encourage you to go to my Twitter to see the video I shared, because the tools to stop this virus are already in our communities. Look at New York City. They've gone from worst in the world to a less than one percent positivity rate for several weeks ongoing. It proves we don't need to wait until we get a vaccine or some miracle drug to get this virus under control. We can do it right now.
It is important that we've come face to face with the terrible inequities that exist in our country. We're in the midst of a major social justice movement, but I remind people that you can't have social justice if you don't have health equity. This virus has laid bare many of the underlying inequities that have existed in our society – five times higher hospitalization rates for African-Americans, for Latinx Americans, and for our tribal brothers and sisters. It's very important that that we understand we have to address these social conditions that then lead to the medical conditions that create these terrible health inequities.
But there is good news out there. We just passed one hundred million tests. We have a 30-day supply of PPE in every state. We have seen cases and hospitalizations and deaths go down continually over the last several weeks.
We appear to have gotten over the summer hump, and what we're now worried about is a post Labor Day and flu season resurgence that could possibly happen.
So it's important for us all to be thinking about vaccines, but I also hope we can continue to drive down cases, hospitalizations, and deaths through basic public measures. That combined with the herd immunity we will increasingly get from a vaccine, plus a commitment to protecting the vulnerable, I think will allow us to open more places and to keep them open. It's not that we need to stay shut down. It's that we all need to understand the measures that we have to take in order to open and to stay open.
Overall, I'm hopeful. I'm hopeful that that with what we've learned about the virus, with the resources we have in place and with the prospect of a vaccine on the horizon, plus drugs like from the severe convalescent plasma already available, that we're getting a handle on this virus. But what we need is really the will of people to come together and actually do the things that we have learned are effective.
When we promote health, we promote a healthy economy. But far too often, health is pitted against the economy.
Suzanne Clark: Do you think that's the biggest challenges you face right now as we go through different phases of this pandemic, is getting people to have the will to stick with it this long, the biggest challenge we're facing?
Dr. Adams: Absolutely. One of the things that I've said to the Chamber of Commerce before is that people do not prioritize health. I don't mean that in a negative way. I just mean when you look at Gallup polls, when you look at what motivates behaviors, the number one issue people vote on is jobs and the economy. And it's why I have consistently tried to help everyone understand that when we promote health, we promote a healthy economy. But far too often, health is pitted against the economy.
You are seeing this with COVID. You've got people in the reopening camp and you've got people in the pro public health camp, and they are constantly at odds with each other. What I'm trying to help people understand is this can be a virtuous upward cycle or a vicious downward cycle. If you're in the public health camp, you have to know that for every 1% increase in unemployment, you have a 1.3% increase in people who try to take their lives by suicide.
We know that that we are delaying diagnoses of cancer, treatment of diabetes, 4.2M children are behind on their vaccinations - all because of the shutdown. There are real health harms and economic harms from shutting down. So the health people can't forget about the impacts on the economy, and the people who care about the economy need to understand that we can't reopen and stay open as long as we have uncontrolled viral spread. We truly are all in this together, and we all need to have the will to work together.
The elephant in the room is that we have a once in a century pandemic - that would be hard in an in and of itself - but there is no chapter in the pandemic playbook for an impeachment trial. It seems like forever ago, but when we first were learning about this pandemic, we literally had our country at each other's throats in an impeachment trial. There's no chapter in the pandemic playbook for a highly divisive presidential election. And there's no chapter in the pandemic playbook for a social justice movement, the likes of which we haven't seen since the 60’s. It makes it hard to have these conversations and for people to have the will to work together.
Kelly Kowalczyk, Gordon Food Service: Do we have any known instances of people getting covid-19 more than once?
A healthy business community impacts families’ and individuals’ health in a good way.
Dr. Adams: The answer is yes, but extremely rarely. And the broader answer for that question is that we're still learning every day about how it behaves. Our belief as health officials is that once you get this virus, you will have immunity for a certain period of time. We don't know how long that is.
All viruses mutate. This virus, has it mutated in such a way that we think it's becoming particularly more virulent or that we're worried that the vaccine that we're developing right now won't work? We haven't seen major mutations in this virus to this point.
Suzanne Clark: You know, it's so interesting to hear you talk about the community impact of something like the flu because it relates directly to something that you care deeply about and we care deeply about, which is this link between economic prosperity, between employment and health outcomes. How has the pandemic influenced that?
Dr. Adams: My report on community health and economic prosperity has been in the works for several years before this pandemic. We knew the health of Americans wasn't as good as it could be and was worse than the health of people in other wealthy nations, even as we pay more for health care than any other nation in the world. You all know as employers that health care for most businesses is your number two expense.
We call this the US health disadvantage. The fact that we pay more and get less for what we're paying than any other country and America's poor health status, it inflicts costs on people, families, businesses and on society.
COVID-19 has exposed the cost of the U.S. health disadvantage. The virus has claimed more lives among those with certain underlying conditions, and it's disrupted our economy to the extent that access to health care coverage has been diminished. In a country where we uniquely provide a significant proportion of our health care coverage through employers, millions of people lost employer-sponsored health insurance. The U.S. health disadvantage increases health care costs, but it also lowers productivity and competitiveness and compromises business success and growth.
If businesses allow themselves to continue to be pitted against health or say that it's not my business to promote community health, then we're not going to just see individual health suffering. We're going to see business bottom line suffer. My Community Health and Economic Prosperity Report really helps businesses understand how the health of the community impacts their business’s bottom line, but it also gives examples of companies that are finding unique ways to contribute to community health.
Suzanne Clark: A healthy business community impacts families’ and individuals’ health in a good way. They all relate to each other. The same thing is true with jail time and prison time and recidivism rates and employment numbers drastically reduce recidivism. People get a job. That's what works.
While we're on the private sector, whenever we talk about a pandemic, when the country has a conversation about the pandemic response, it's quick to go to what the government is doing. But the private sector is also playing a pretty big role in getting us through this pandemic and getting America healthy again. Can you talk for a second about that?
Dr. Adams: One of the things that has been interesting, and I think needs to be one of the lessons learned from this pandemic, is that by design, by intention, by the request of many of you all on this call, the government has decreased regulations and put a lot of our capacity towards innovation. I believe personally that things are best handled at the local level and things become very difficult when you try to manage a local response from Washington, D.C. So one of the lessons learned is that we need to do a better job of empowering and enabling and being able to quickly unleash local innovation and local capacity.
Emily Yu, De Beaumont Foundation: My question today is, given the opportunity we have and some would even say the necessity to really reframe how we think about public health moving forward, how can businesses help rethink public private partnerships moving forward for better community health for all?
Dr. Adams: I'm a big a big proponent of these partnerships. My motto is “better health through better partnerships,” because I believe health is local and that that things work best when we leverage innovation, the passion of the local community, and our private partners.
One of the things we're trying to do from a federal level is make it possible for people to work with other partners. For example, this administration has approved a record number of Medicaid waivers, which gives states the flexibility to be able to work in health endeavors with partners that they haven't before. I would encourage you to also reach out to the faith-based communities and law enforcement communities, because unfortunately, those in law enforcement community are our number one mental health providers in this country. That's not the way it should be, but it's the way it is.
In many cases, they have visibility and insight problems and an opportunity to intervene that that others may not. And again, the faith communities out there are on the front lines constantly. They're the ones that are providing the food banks that that that are helping your employees in many cases, be able to eat on a day to day basis.
Ted Heckmann, Cincinnati Bell: We have recently seen the media that the CDC is advising states to gear up for vaccine distribution by November. Are we really that close to a vaccine or vaccines? And is it realistic to think states have the needed resources to accomplish the ramp up and implementation?
Dr. Adams: So the CEO of Pfizer has said that they expect a signal by October or November in terms of a vaccine. What does that mean? I want people to understand that we aren't compromising on safety here by any means. The safety processes and signals will be as strong as for any vaccine. And honestly, when you talk to health experts, they will tell you this will be the most scrutinized vaccine of all time. It is very likely that we will have a stronger safety and efficacy signal at the time of vaccine approval than we've had for any other vaccine at the point of approval.
Why is that? The FDA says you need to have 3,000 people minimum in a safety trial. Each of the trials has 30,000 people in it. It’s also important to know that there are independent boards, institutional review boards, data safety monitoring boards that will determine whether or not this study is unblinded. So we in the government actually don't have the ability to intervene until an independent board has said that this drug is safe and effective.
Our strategy is going to be to vaccinate the vulnerable and front-line workers first, because we feel that that's going to have the biggest impact.
Suzanne Clark: Can you estimate if there are three hundred thirty million Americans, how long it takes to get everybody vaccinated?
The most honest answer I can give you is anyone who would speculate is truly just speculating. But our strategy actually is going to be to vaccinate the vulnerable and front line workers first, because we feel that that's going to have the biggest impact. So really, it's not so much about getting everyone vaccinated as it is getting the most vulnerable and the people who are most likely to encounter disease vaccinated so that we can break transmission. And I feel pretty good that we can start getting vaccines out by the end of this year, early next year. And if we use that strategy, protecting the vulnerable in front line workers first, then we will see an impact from this in short order.
Suzanne Clark: I want to shift topics a little bit to what you and I discussed the last time we were together, which was this opioid epidemic. I know it's been a great focus of yours. Now we're seeing evidence that overdose deaths are rising. Suicide rates, as you mentioned a minute ago, are rising. What do you make of this trend and what is it that we can be doing as a society to stem that tragedy?
Dr. Adams: Even before COVID-19, we saw that life expectancy had been trending down for several years in a row, and we knew that in many cases this was due to diseases of despair - depression, anxiety, substance misuse, suicide. It’s important that, as employers, you look at your coverage for mental health services and substance use disorder in particular, because it actually is an investment that pays dividends. If you don't fund those benefits, that is going to hurt your bottom line.
You need to look at destigmatizing substance use disorders. Stigma kills more people than cigarettes or heroin or any other or any other issue out there. Stigma kills more people than COVID-19.
We need to destigmatize substance use disorders so that people feel comfortable seeking help. And you can do that by sharing stories, but also by being willing to hire people who are in recovery.
And then I put out a Surgeon General’s Advisory on naloxone - learn about it and be willing to carry it - because 70% of overdoses are by people who have who are employed. We like to think of substance use disorders as some homeless person who's detached from society in a back alley. But most of the people who are misusing opioids are your employees right now.
Suzanne Clark: As the nation's doctor, if you could tell this audience your advice on keeping up with routine screenings, routine testing, routine physicals, treatments for chronic conditions, versus being afraid that if they go to the dentist, go to get a mammogram, go to their doctor, they're putting themselves at risk and COVID-19. As the nation's doctor, what should we be doing about our routine health issues?
Remember the three W's: wash your hands, wear a mask and watch your distance.
Dr. Adams: It's critically important that people understand that it is safe - that health care facilities have ample practices in place to bring you in safely for screenings and preventative services. If you have any concerns, we've also substantially increased the availability of telehealth services.
So as employers and as individuals, I encourage you to get screened yourself and to encourage others out there to get their physical, get their children's vaccinations, make an appointment today. What I fear is that we will, in the long run, see that many more people harmed from diseases other than COVID-19 that got missed during the shutdowns than people who actually passed from COVID-19.
That's not to compare one versus the other, but it would be a real tragedy if we could prevent many of these deaths from occurring. Speaking of prevention, I want to finish with my three W's. Very important to understand that again, Italy, Spain, Wuhan, New York City, even Arizona, were some of the worst places in the world at some point for transmission of COVID-19 are now some of the best places in the world. And they did it without a vaccine.
They did it with the three W's: wash your hands, wear a mask and watch your distance, meaning avoid crowded indoor spaces and stay six feet from others. If we do these three things - and they're not hard things to do - we can drive down viral transmission. We can successfully and sustainably reopen. And then when we stack a vaccine on top of that later this year, then we can really drive this virus into the ground and get back to some sense of normal in the future. A new normal, hopefully a better normal, where we recognize that we need to address inequities in communities where we embrace public health practices we truly do realize that we are all stronger together.
I believe that the business community is critical to the nation's health. And I believe the nation's health is critical to what you care about and what you do each and every day. So let's do this together.
Watch the full conversation below: