• African Americans and Latinos make up a large percentage of America's essential work force.
  • Existing data does not group COVID-19 cases, deaths, or testing access by population, race, and ethnicity.
  • Transparent, open communication regarding a pandemic from government officials is critically important but lacking in today’s COVID-19 society. 
  • Reopenings must be done very carefully and slowly and based on the best available public science. 

Video Transcript

[MUSIC PLAYING]

JOHN WHYTE: You're watching Coronavirus in Context. I'm Dr. John Whyte, Chief Medical Officer and WebMD. I'm delighted to be joined today by Dr. Richard Besser. He is the CEO and president of the Robert Wood Johnson Foundation. Dr. Besser, thanks for joining me.

RICHARD BESSER: Thanks, John. It's great to be here.

JOHN WHYTE: I want to start off with the issue of disparities. Your foundation has always been interested in addressing disparities. And in some cities of the country, we're seeing six times the death rate in minority populations. What are we doing, and what should we be doing, to combat this racial disparity in COVID-19 cases and deaths?

RICHARD BESSER: Yeah, I-- you know, I-- I think that's-- that's a critically important question. Uh, if-- if you think about how society was, uh, several months ago before this crisis hit, uh, for many in America, uh, they were living on-- on the edge. Millions of people in poverty, uh, millions of people who live paycheck to paycheck, uh, major health disparities.

Uh, you know, I live in Princeton, New Jersey, where-- where a child born here has a life expectancy of 87 years.

JOHN WHYTE: Wow.

RICHARD BESSER: 15 miles down the road in Trenton, New Jersey, same-- same county. It's our-- it's our state capital. Uh, a child born there has a life expectancy of-- of 73 years.

JOHN WHYTE: Mmm.

RICHARD BESSER: So you have major disparities to begin with. Um--

JOHN WHYTE: Pre-COVID-19.

RICHARD BESSER: Yeah, before COVID-19.

JOHN WHYTE: Yeah.

RICHARD BESSER: And then COVID-19 comes. And you have-- you know, there's a lot of reasons going in here, but a lot more work has to be done. You have very high proportion of-- of black and Latino, uh, uh, people in this country who work in what are considered essential occupations. Uh, and with that, they are putting themselves at risk. They're putting themselves at risk to make sure we have food on our tables, that our streets are safe and clean. Uh, many working in-- in homes as-- as, uh, home health care workers, in hospitals.

And so if you're on the front in these jobs and you don't have personal protective equipment, you're at increased risk. Um, millions of people in this country without health insurance. And so when they get sick, um, might be slower to be tested, slower to be treated. So lots of factors here. Lots of things that can be done right now and need to be done right now. Uh, but a lot also comes down to-- to structural racism and-- and where we were as a society when this started.

JOHN WHYTE: Will more testing help address this issue? Because if we don't know someone has coronavirus, we can't help treat them. Or is not-- not as important, right [INAUDIBLE]

RICHARD BESSER: Well, I-- yeah, I-- I think testing is really important. But it's also important who is getting tested. We're not seeing statistics on testing by population, testing by race and ethnicity. Um, as we move forward with testing-- and testing is going to be critically important when we move from a strategy of everyone stays at home and-- and hunkers down to one where you try and identify cases quickly and-- and provide isolation, uh, contact tracing, and-- and quarantine. Um, as you move to that kind of system, we want to make sure that testing is available for everybody. Um, otherwise you're going to-- you're going to further amplify the disparities that we see-- we see at present.

Uh, and most-- most locales are not reporting data by-- by race and ethnicity for cases and-- and deaths. And I haven't seen any data, uh, broken out that way for testing.

JOHN WHYTE: And lately we've been shifting our focus onto antibody testing. And there's been a concern that many of these tests, especially point of care testing, are not as accurate as we need to be. Or they're not quantitating the type of antibodies that might be important in conferring immunity and protection. Wh-- what are you hearing about antibody testing and where we might need to be going?

RICHARD BESSER: Well, yeah, antibody testing is going to be very useful, very important. Uh, but for it to be used for public health purposes or for clinical decision making, it has to be tested. It has to be validated. And FDA has made the decision to let a lot of tests go forward without external-- without, uh, scientific validation apart from what a company does.

And so until there's-- there's further testing on this, um, and we don't know at this point, uh, whether a positive test truly means someone has had a COVID infection before or whether it might, uh, be reacting to some other type of virus that a person had-- had in their life. We don't know what levels of-- of antibodies or protective factors might suggest that a person is truly protected. Uh, we don't know that if someone has protective, uh, levels that they-- whether or not they could get infected again or spread the disease to someone else. So--

JOHN WHYTE: So why are we doing them? [LAUGHS] Why-- [INAUDIBLE]

RICHARD BESSER: Well, you know, it-- they're impor-- it's-- it's important to-- to get tests that are validated. But it's definitely too soon to be making any decisions based on these. Uh, it's-- it's way, way early.

But you know, I-- I worry that so frequently what we hear in the media are these magic bullets without, uh, taking the time to explain the science that has to be done to make sure they're-- they're used properly and we understand what the results mean.

JOHN WHYTE: You're on this multi-state regional council to reopen the economy. And everyone's talking about, uh, whether or not it's too early, or is it OK to do. What do we need to know, and how do we decide? And-- and what are you thinking about as you're part of this council to-- to reopen the economy, reopen the state, however we want to phrase it.

RICHARD BESSER: Yeah. Well, you know, I think we want to do this carefully, slowly, and-- and based on the best available public health science. And there-- there are a number of things that have to be in place to be able to-- to meet those criteria of doing it safely.

Uh, the first is you have to make sure there's enough capacity in your health care system. Because when you start to loosen up some of these, uh-- these requirements, uh, and let people come out a little bit more, we are going to see more cases of COVID. It's-- it's inevitable. So you want to make sure there's enough beds to take care of-- of people. There's enough health care providers. There's enough protective equipment for those people who are-- are providing that care.

You want to make sure there's enough care in your-- uh, enough room in your health care system to take care of all of the other medical problems. You know, they didn't go away during COVID. There's still people who need surgery for cancer. There are people who need treatment of their heart disease, of their kidney disease, of their diabetes. So there has to be room in the health care system, or-- or as soon as you start to-- to loosen things up and open up, you'll-- you'll have an overwhelmed system again.

Then you want to make sure there's sufficient testing. Because right now, most states, most-- most hospitals are only testing people who are severely ill. And we know that there's a wide range of illness with COVID. There's people who have no symptoms. But you at least want to be able to test people who have mild symptoms.

JOHN WHYTE: Mm-hmm.

RICHARD BESSER: Because while it may be mild for them, they could be the person who spreads it to someone else who's at high risk. So if you can identify everyone who-- who is sick--

JOHN WHYTE: Mm-hmm.

RICHARD BESSER: --then-- then do basic public health. Identify all the people those people have had contact with--

JOHN WHYTE: Right.

RICHARD BESSER: --and tell them to spend two weeks away from everybody else, uh, so that they don't spread it if they get sick.

JOHN WHYTE: What's the [INAUDIBLE]

RICHARD BESSER: In addition to that--

JOHN WHYTE: Mm-hmm.

RICHARD BESSER: You need to make sure that everyone in America can do those things. And that means thinking about creative ways to provide safe places for people to-- to isolate or quarantine. Hotels, dormitory rooms. There's all kinds of ways you can approach it. But just sending people home means that you're saying to those people who live with someone who's elderly or live in a-- a small apartment with many people that you don't really care whether they spread it to their families.

JOHN WHYTE: You mentioned contact tracing. And that's what I was going to ask you. Some people have said there's no way we have enough public health officials to do that, even if we hire 100,000 more people.

So what's the role of tech? Google and Apple have been talking about, hey, we can use technology-- Bluetooth, location services, whatever-- to play a role there. Does that really have a role? Or is there just the cultural issues here in the United States that we're not going to give up that amount of privacy to advance public health?

RICHARD BESSER: You know, I-- I think that technology can be a tool that's-- that's part of this. Uh, but you're not going to be able to replace the-- the need for public health workers. You know, one-- there-- there are a lot of people who are out of work. And so there are people who can be trained to do this kind of work.

And-- and one thing-- you know, a-- as you move towards a strategy where you're going to try and identify cases and do contact tracing, the public has to believe that this is in their best interests. Contact tracing involves asking all kinds of very personal questions about where you've been, who you've been in contact with. And so recruiting people from diverse communities so that people are doing contact tracing in the communities in which they live would-- would allow people to-- to, uh, feel more comfortable with providing this information, uh, with-- with participating in this.

And then, yeah, there are tools that could be used to-- to ensure that you're-- you're collecting this information and sharing it. One thing that-- that, uh, uh, you know, this regional group will-- will be talking about is, how do you share this kind of information across states? Someone in New York City, uh, isn't limiting their contacts to people in New York City or New York state. You want to make sure that you can share information with Connecticut, and New Jersey, and-- and other places. And technology, I-- I would think, would have a role to play there.

I-- I worry greatly about the-- the thinking that technology-- uh, using it as location trackers would-- would allow you to say where a person's been and who they've been in-- in contact with with devices. I think it's, uh-- it's a slippery slope in terms of personal privacy. And-- and, uh, I think very few people would trust big tech with that kind of information.

JOHN WHYTE: You were the acting director of the CDC during a different pandemic. And you were out there every day talking to the country about what we needed to do, what we knew, what we didn't know. Why do you think we're not seeing the CDC front and center during this epidemic?

RICHARD BESSER: You know, I-- I wish I knew the answer to that, John. Because I-- I think that-- that transparent, open communication, uh, was critically important. It was a critical success factor for us in 2009. And we're missing that right now.

It's very hard to know what things we're being told for public health reasons and what things we're being told for-- for policy reasons, and what things we're being told for-- for political reasons. And-- and I found it very valuable when I was in that role to have the media asking me really hard questions. It improved our work. It-- it forced us to go back and say, well, why aren't we thinking about that? Why-- why haven't we-- we answered that question? What can we do to find out that information?

And-- and CDC isn't getting that interaction right now. And the public isn't getting to hear from the world's best public health scientists.

JOHN WHYTE: And the media world has changed since then, even over the last few years with the proliferation of social media. Everyone who has a blog seems to be an expert in-- in public health and epidemiology. So what guidance do you give folks in-- in terms of where they should go for that information? The CDC is a great site. But let's be honest, in this day and age, a lot of folks don't end up there as-- as well as they should. But how should we decide how we trust the information we hear, we read, we find online?

RICHARD BESSER: Yeah, it's-- it's a much bigger challenge now than it was in 2009. It was challenging then with all kinds of misinformation--

JOHN WHYTE: [? Sure, ?] [? yes. ?]

RICHARD BESSER: --and, uh, fake cures out there on the internet. But now we have such a hyper-polarized society and people getting their information from, uh-- from very different voices. Uh, it-- it makes it challenging.

I-- I tend to recommend government sources as a good place to start. So the CDC website, NIH, uh, FDA. FEMA has a rumor control site that-- that I like. Johns Hopkins has a terrific resource center for-- for COVID. Uh, preventing epidemics, which is Tom [? Friedan's, ?] uh, uh, organization out of, uh, New York has-- has terrific materials.

Uh, and then once you find a site that is really good, uh, many of these sites also have links to other sites--

JOHN WHYTE: [INAUDIBLE]

RICHARD BESSER: --that-- with-- with high quality information.

JOHN WHYTE: Mm-hmm.

RICHARD BESSER: But-- but just clicking on whatever someone shared with you--

JOHN WHYTE: [? No. ?]

RICHARD BESSER: --on-- on Facebook, that can lead to some-- some big problems.

JOHN WHYTE: [INAUDIBLE] Well, Dr. Besser, I want to thank you for taking the time today to share your insights.

RICHARD BESSER: Thanks so much for having me, John. It's a-- it's a real pleasure.

JOHN WHYTE: And thank you for watching Coronavirus in Context. I'm Dr. John Whyte.

[MUSIC PLAYING]