March 26, 2020 • 47 mins
On this episode of Next Question with Katie Couric, Katie continues her special coverage of the coronavirus pandemic. First, Katie looks to New York City — now the national epicenter of this crisis — where the rate of positive COVID-19 cases is doubling ever three days. Which means the peak of coronavirus infections will be much higher and hit New York much sooner than expected, giving the city's vast network of hospitals — which are already under tremendous strain — less time to prepare for a deluge of patients. Katie talks to Dr. Robert Femia, the chair of emergency medicine at NYU Langone to find out how emergency rooms in New York City are faring now and how they are bracing for what's to come. Then, Katie speaks to Beth Cameron, the former head of the National Security Council Directorate for Global Health Security and Biodefense, about why the U.S. wasn't prepared for this pandemic. Beth Cameron is now the Vice President for Global Biological Policy and Programs at the Nuclear Threat Initiative, which has a new effort to help local officials during the COVID-19 pandemic. You can find more information about that here.
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Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Speaker 1 (00:00):
Hi everyone, I'm Katie Kuric, and welcome to next question. Today,
we once again are dedicating our full attention to the
coronavirus pandemic, which continues to spread across the country, growing
at alarming rates in the most populated areas. In fact,
on Friday, March, the Mayor of New York City, Bill
(00:21):
de Blasio, marked a distressing new milestone. I hate to
say this, but it's true. We are now the epicenter
of this crisis. New York State has nearly half of
the nation's coronavirus cases, and the number is growing faster
than anyone predicted. As of this recording, the positive COVID
(00:42):
nineteen count in New York City is doubling every three days.
Here's Governor Andrew Cuomo. On March, one of the forecasters
said to me, we were looking at a freight train
coming across the country. We're now looking at a bullet train,
because then numbers are going up that quickly. What that
(01:02):
means is that the peak of coronavirus infections will be
much higher and hit New York much sooner than expected.
Giving the city's vast network of hospitals, which are already
under tremendous strain, less time to prepare, less time to
get the critical equipment they need to care for those patients,
and less time to replenish their stash a protective gear
(01:25):
so that medical staff can continue to work without getting sick,
Which leads to my next question, how are emergency rooms
in New York City faring now? And how are they
bracing for what's to come? And later on what could
have been done to allow us to be better prepared
(01:46):
for this pandemic. But first, Hi, rob Hi, Hi, it's Katie.
How are you? How are you doing? Oh? My god?
Thank you for taking time to do. Dr Robert Semia
is the Chair of Emergency Medicine IT and y you
Land Gown in New York City. In that role, he's
(02:07):
in charge of the emergency departments of several n y
U hospitals across the metropolitan area. We see about five
thousand patients in all of our emergency departments across Manhattan, Brooklyn,
and Long Island, and we've seen a couple of consistent things.
One Overall, at the majority of our emergency departments, the
(02:30):
volume is down, but we have a huge spike in
the number of respiratory cases that are serious requiring requiring intubation,
and that numbers seems to be growing every day. I
get a I get a report every twelve hours from
our emergency departments Shift report one of our a d s. Yesterday,
in a twelve hour period intubated seven patients had put
(02:54):
them on ventilators. That's a huge number for one twelve
hour period of time. And then you know we have
very The next day might be one or two. The
next day it might be six or seven again, so
there's capacity right now, but everyone's trying to figure out
how do you make sure that there's capacity down the road.
To help with some of this, we stood up a
(03:16):
twenty four hour a day video visit telemedicine, where now
we're seeing a thousand visits on a telemedicine platform trying
to keep people off the subways from spreading disease, giving
them advice, and keeping them out of the emergency departments.
So we have seen some good impact there where our
(03:37):
overall eat volume is down for people that are not
seriously ill, but we have seen a huge spike in
the number of people who are very sick and needing
to be put on ventilators. Well, let's first talk about
the telemedicine patients rob you're seeing. Basically, they need to
know if their symptoms are serious enough to go to
the hospital, if they in fact have COVID nineteen. In
(04:00):
most of those cases, are you able to encourage them
to in fact stay at home and to self quarantine.
We have. One of the things that the telemedicine visits
that we're seeing is that there's a lot of public
fear and it's grounded in in really a lack of information,
(04:20):
and so we're seeing many patients who really have a
couple of questions. One, they want to know if they're
going to get seriously ill suddenly and die. Number two,
they want to know if they need a test for COVID.
And number three they want to know, Okay, what symptoms
do I watch for if I quarantine at home. When
someone calls you, particularly an elderly person, and worries that
(04:44):
that person is going to be come extremely ill from this,
what do you tell them? The majority of calls that
we're seeing are from people that are younger that have
symptoms that most of us, if it wasn't this pandemic,
would think our typical winter rest the tory colts, low
grade fever, cough um right, no sore throat. The issue
(05:06):
is that those symptoms overlap with the same symptoms as
COVID and UM. What I tell patients is that most
of us will probably are many of us will probably
get COVID and UM not even realize that. We'll just
think at the winter cold and the majority of us
will do just fine. UM. And really the people that
need to go to the e r s are those
(05:27):
who have those typical resttory symptoms and then those symptoms
progress to UM shortness of breath and difficulty in breathing,
and so we give them advice about that, and we
also talk about the need for testing. And for most patients,
what we tell them is, you know, if your symptoms
are in that minimal group right now, you're not having
shortness of breath. Whether you have a COVID test or not,
(05:50):
does not change the information and the guidance that I'm
going to give you right now, which is to stay
at home self quarantine um UH. Go to the CDC
or the government websites. UM. If you're unsure about the
best way to self quarantine at home. We usually tell
people you should do things like if you share a
bedroom with someone, to sleep in a separate bedroom, if
(06:11):
you have a second bathroom, try to use that bathroom,
do good disinfection of counter surfaces, and those things. And
then we give them guidance about what you need to
watch for, and that being the increasing shortness of breath
and for those patients, you should come to the emergency department.
Most people are pretty relieved when they hear that because
(06:31):
they're just not sure. The experience that we're seeing in
the emergency department is that the majority of the patients
that are ending up on rest but on ventilators are elderly,
but we are seeing people in younger age groups that
are very sick. Also. I'll tell you what's been the
uplift thing part of these conversations is that we're seeing
(06:52):
many people that are younger generations that are sick, and
they're telling me, you know, I don't want to go
out and potentially infect older people, and I don't want
my grandmother and my grandparents to be at risk, and
so um, that part has been very uplifting to to hear.
So it's that's positive because we've seen so many stories
(07:13):
rob of of kids going on spring break and being irresponsible.
So it's nice to hear that younger people are actually
thinking otherwise than trying to be more responsible. Let's talk
about personal protective equipment or PPE, a word that the
general population now understands that used to be the purview
of the medical community. We're talking about the mass, the gowns,
(07:36):
the gloves that protect you and your team from coronavirus. UM.
Are you all getting the equipment you need? There's not
enough and UM we have the equipment now, but we're
worried that UM, as is everybody that will run out,
and so we started conservation measures that are safe, but
(08:00):
they're psychologically taxing on the doctors and nurses at work.
So UM. Some of the things that we've done UM
are to cohort any patient that comes into emergency departments
into just one area of the e er. Whereas before
all this happened, you you know, we have multiple teams
and we have big emergency departments, and you could go
(08:22):
to any part of the emergency department. Now we we
put all the patients in one area that have those symptoms,
and in that area are doctors and nurses where those
and nine masks that you're probably hearing about and those
masks are in short supply. And and how those masks
help is they help with airborne or or virus that's
(08:44):
floating in the air, and typically they're used for tuberculosis
or things like that. COVID appears to be mostly droplets,
so somebody sneezes on you, costs on you. Those that
liquid hits you, um and doesn't really hang in the air,
but there are some indications that for certain things it
does hang in the air, like when we're doing an
intubation or those things. So, UM, what we've had to
(09:05):
do is to somewhat limit how many times we change
out of that equipment, so you might wear your same
mask with a face shield, for example, on the entire shift,
instead of changing it multiple times to shift. We do
change our gowns and other things. Or if we get sprayed,
(09:26):
of course we change. But that's something that we never
had to do. We never had to worry about conservation
and UM, to an im introom doctor or nurse, it's
it's an emotional drain. Um. You're already in a in
a and basically a space suit that you can only
(09:48):
change up part of it. You're hot, you're sweaty. Yeah,
everybody's concerned that. You know, can the supply and chain
catch ups? Anybody who works with you have any of
your colleagues got sick? Yes, Um, so many of our
people have gone sick. Doctors and nurses with fevers or costs.
(10:10):
We they all get sent home. When COVID testing was available,
they were tested, some of them positive, some negative. The
good news is all of all of our people who
actually have been positive and sick are all better and
return to work. Now we've done some things. We do
have some more senior physicians. We've kept them uh in
(10:34):
parts of the emergency department where they're not exposed, you know,
just knowing that that most people that have a little
more candles on their birthday cake are more at risk.
But no, the good news is is at n y
U Land going here, every every one of our doctors
and nurses that's gotten sick has recovered us fine. I
want to bring up a question from a listener. Her
(10:55):
name is Mary, she's a nurse. She doesn't say where
she works, but she wondered if how care workers should
isolate themselves from their families. I'm assuming even if they're
asymptomatic if and if so, how have you gotten such
a question yourself? What are you advising your colleagues to do? So?
One of the things is that, UM, you know, just
(11:18):
like the general public. UM. You know, our colleagues and
the emergency departments UM here in New York and across
the country come to work every day. But everybody has
their own anxieties about this, and so for example, UM,
we've created the ability for people to shower before they
actually go home because they're wondering, am I going to
(11:39):
spread something? Am I an asymptomatic career? I have people
that I work with who have decided they have a
little baby at home, and with their seeing they pan
out there that they're not going to go home, They've
got a friend's place to stay at, who has a
vacant apartment, of those kind of things. All those questions
we run we run by our infection disease specialists. But
I think you know a lot of people, even when
(12:01):
they're doing the best practices at home, whether that's trying
to keep a distance, even though they may not have
any UM symptoms, they're still wondering. They're still worried for
themselves and their word, for their family, and so they're
taking whether it's appropriate, precautions, extra precautions. Yeah, people worry
about those things and they try to keep some distance. UM.
(12:23):
When I do these videos is it's also sides working
in the dy we do get people. Another group that
we're concerned about is if you live with somebody who's
immuno compromised. You know, I've had people tell, you know,
talk to me saying, you know, they can't get COVID
testing as of today. Um. That seems to be constantly
(12:44):
changing the availability of public testing. They're concerned because someone
they live with has multiple miloma or some form of cancer.
They're aware that those people are at an increase risk,
and so they want to do the right thing. Try
to keep their distance, try to socially isolate, but try
to do that while you're sharing a home with somebody.
(13:04):
I had people tell me they're living in their basement
if they have a basement. Um. So there's a lot
going on, um as people try to keep each other
as safe as possible. When you think about the next
few weeks, do you have any idea when this is
going to peak? No idea, I don't you know, I
(13:25):
don't know. UM, you know, it's hard hard to say, UM,
I'm seeing sicker patients and in increasing numbers. I don't
know when that will level off. Our general approach is
that we need to be prepared for this to be
a marathon and not a sprint, and so making sure
(13:45):
that our doctors and nurses get adequate respite, making sure
that we have relief physicians and nurses available should it,
should much of the workforce go down temporarily or have
to go home because they're sick. For approaches, UM do
our best on a day to day basis, but our
eyes looking down the road always tell people that you know,
(14:06):
working in an emergency department on a regular day is
like running a two minute no huddle offense in football,
but for eight hours. And now you throw in, UM,
some uncertainty into that mix. It's it's like you're trying
to do that in a swimming pool. But UM, people
that work in emergency departments are special. They have big hearts,
(14:29):
They feel for patients and human suffering, and UM are
really up for this challenge and and just want to know.
I just want to feel that their support for them,
and that support looks like proper ppe and UM, I
will tell you that doing some of these videos. Its
(14:50):
also has been uplifting because so many times people have
expressed gratitude for what e R doctors and nurses do.
We're getting more thank you than we normally do. We're
seeing young people talk about how they're worried about older folks,
and there's this multigenerational kind of commitment and kindness and
(15:12):
empathy that's on display. So, UM, yeah, you know, we're
all as a nation going through a lot, and we're
all in this together. But I've seen some really encouraging
signs of um, what the future looks like and um
seeing a lot of people's in her kindness right to
(15:33):
the surface, and that makes me feel really good. That
was Dr Robert Famiett, Chair of Emergency Medicine at and
why you land gone in New York City and why
you may be managing now, but other hospitals around New
York City and indeed the country are already struggling under
the pressure of the coronavirus and the weeks to come.
(15:55):
I'll be continuing to reach out to those working on
the front lines of this pandemic, and I'll bring you
those stories here on this podcast, also on Instagram. Live,
which you can find by searching my name Katie Curic
on Instagram. Up next, why wasn't this country better prepared?
We'll talk with an expert whose job was to do
(16:18):
just that. Welcome back, everyone. We're continuing our coverage of
the coronavirus this week, taking a look at pandemic preparedness
(16:42):
from the emergency room to the oval office. Hi, fa Hi,
thanks so much for doing this. Beth Cameron is the
former Senior Director for Global Health Security and Bio Defense.
This unit, which was a part of the White House
National Security Council, was established by the Obama administration after
the two thousand fourteen Ebola epidemic, and it was intended
(17:06):
to be a smoke alarm, a warning of the first
signs of a global health crisis. In two thousand eighteen, however,
the Trump administration disbanded the unit. The Office of Global
Health Security and Bio Defense was set up after the
Ebola epidemic in order to get ahead of outbreaks before
they become epidemics or pandemics. We're really worried coming out
(17:29):
of Ebola. It was a hugely devastating outbreak that killed
over eleven thousand people. UM, but we were looking at
that as ultimately an event that stayed relatively circumscribed to
three major countries. Of course, there were lots of concerns
that it would spread more rapidly, and there was a
huge global intervention that the US helped lead to keep
that from happening. But we were very worried about exactly
(17:52):
what we're seeing now, a large scale respiratory illness that
would become a pandemic, and we knew that we weren't
prepared for that as a nation or as a world.
Let's imagine a world in which that office had not
been dissolved and you were still leading at Beath. What
role would it be playing right now in the midst
(18:12):
of this crisis. It would really be the best way
to describe the office's role now would be as a
coordinating hub. So the office was playing a role in
in working with high level senior officials and sending information
about problems and issues up the chain so that they
would be resolved quickly. But also really importantly, we're listening
(18:34):
to staff at the working level across departments and agencies.
So when there was a problem or a challenge or
a need in the States or in another country. We
were able to figure out, Hey, what's the real issue,
who's not agreeing, and then elevate it really quickly. You
helped transition the incoming Trump administration. You directly briefed then
(18:57):
Homeless Security Advisor Tom Bossard. Did you have a sense
at that time the new administration was committed to the
objectives of this office. Yes, during the transition, I had
quite a good experience with transitioning this specific office from
President Obama to President Trump, and both the outgoing team
(19:19):
and the incoming team, particularly as you mentioned, Homeland Security
Advisor Tom Basser had been through um pandemic threats before
in the Bush administration, and so there's actually quite a
lot of support for continuing the role of this office,
and not only from Tom Basser, but also from National
Security Advisor HR McMaster, who I briefed before I left.
(19:40):
You said you were mystified when the Trump administration dissolved
the office in May of two thousand eighteen. Now there
seems to be a difference of opinion here with your
op ed in the Washington Post and someone within the
Trump administration name Tim Morrison, who believes that your account
was wrong. So tell me as you understand it. What happened?
(20:03):
Can you explain? I can, and and I think that
Tim's op ed was less of a rebuttal of what
I said and more of an explanation of the organizational
structure UM and what happened. So my understanding of what
happened is that Tim Zeemer, who took my position as
the head of the Office UM, left the White House
and the people who worked on his team were dissolved
(20:27):
and were moved into another director at the director that
Tim Morrison ran. And it's definitely true that some good
policies did come out of that office following the dissolution
of the pandemics team. But the difference, the critical difference,
is that there wasn't a team or a senior level
(20:47):
person whose only responsibility it was to handle pandemic threats.
And that was something that coming out of the BOWLA
Epidemic re realized was missing. That we were all focused
on epidemic, we were all focused on the BOWLA outbreak,
but we didn't have a singular mission with a direct
reporting line to the National and Homeland Security Advisor where
(21:08):
our job was only to focus on that issue. And
it's like a transnational threat like counter terrorism um, like
climate change, it's something that when we see what's happening now,
it's easy to understand why you'd want to have a
singularly focused pandemics team. But when you don't have a
pandemic happening, I can see how it would how a
(21:29):
national security advisor might look at that and think, well,
maybe we don't need a team that's solely focused on
this issue, and I just completely disagree with that. This
is a lesson that lots of administrations have learned. So
there have been senior level officials in the last couple
of administrations focused on pandemic threats, and usually it's after
an outbreak or a pandemic when that lesson um is learned.
(21:51):
And so one of the things that happened in the
Obama administration is a couple of lessons came together. One
of those lessons was that we needed a senior level
official who's only job it was with a direct reporting
line to leadership. The other lesson is that we needed
a team that looked at homeland and national security issues together.
When President Trump was asked about this Beth during one
(22:12):
of the White House press conferences, he insisted he didn't
know anything about that, But you did disband the White
House Pandemic Office, and the officials that were working in
that office left this administration abruptly, So what responsibility do
you take to that? And the officials that worked in
that office said that you that the White House lost
valuable time because that office wasn't disbanded. What do you
(22:33):
make of that? Well, I just think it's a nasty
question we've done. Were you surprised at that and who
exactly was in charge of getting rid of the position?
I was surprised by that. Um. I was surprised because
there was quite a lot of press about getting rid
of the office in when it happened, and there were,
you know, a number of high level people in Congress,
(22:56):
UM think tanks who wrote letters or spoke out and
said that this was a mistake. So I was surprised
that he wasn't aware. Um. The all I can say
is that the dissolution of the office happened around the
same time that Tom Bosser left, so right after he
left and right as National Security Advisor John Bolton came
on board, and so I think this really was part
(23:18):
of an overall restructuring and a decision was made that
this reorganization was a was a better organization for the
White House. The White House is to choose its organizational structure.
But it's unfortunate that this lesson got unlearned in the process.
Let's talk about some of the warning signs though, that
existed for this current epidemic pandemic. Rather, can you talk
(23:41):
about some of the flashing red lights that we saw
because there were a number of them, weren't there. Yeah,
there were a number of them. Um, you know, going
back to the beginning and watching the outbreak unfold in China,
looking at a novel coronavirus that had um the ability
(24:01):
to spread between people. That was definitely something in our
playbook of concerns, you know, a new disease that could
spread more quickly between people with with a higher mortality.
And I think the second that that information became available,
that would have flipped a switch for us to start
meeting more regularly and thinking about what kinds of what
(24:23):
kinds of preparedness plans we needed to put in place
or dust off in the United States. And when was that?
That was in January when those cases really started coming
coming to light. There was absolutely a bit of a
delay in the world learning about this, But we did
learn about it um in January, UM, several months ago.
I want to mention something even prior to that. According
(24:45):
to The New York Times, there was a training exercise
led by multiple federal agencies, twelve states, and private stakeholders
that simulated a scenario where respiratory virus dubbed the crimson
can tajun rapidly spread through the United States. What can
you tell us about that, because before we talk about
(25:07):
January February, let's talk about October. Yeah, well, we can
go back even further than than October. We can go
back to the transition between the administrations. So back in January,
before the Obama administration left, there was a half day
um discussion between the outgoing cabinet, the outgoing White House leadership,
(25:29):
and the incoming team, the presumptive nominees for the Trump administration,
And we looked at a number of homeland threats and
one of the small number of things highlighted for the
incoming team was pandemic was pandemics. So I was in
that discussion and helped put that that discussion together, and
there was a very robust conversation between outgoing officials and
(25:51):
incoming officials about a respiratory agent um in that place,
I think we were looking at a flu variant that
could do something very similar to what's happening now. And
then fast forward to a number of tabletops that happened
outside of government, as well as the one highlighted in
the New York Times, which actually I was not aware
of that exercise and wasn't in government when it was conducted,
(26:14):
but reading the reports of it, it looks eerily similar
to what's happening now and certainly is something that White
House leadership should and would have been aware of. So
why do you think they didn't pay attention to that?
I mean, the serendipity of that simulation is pretty uncanny.
I think a couple of things, just having gone through
(26:36):
these exercises, they can they can based on who's in
charge of of acting on what comes out. They either
become playbooks for action and urgent action, or they become
overwhelming and people don't know where to start to fill.
What is apparent now to us in the world is
just a massive, massive set of gaps in pandemic preparedness.
(26:58):
So um, all I can say is that this was this,
this issue of pandemic preparedness should be funded the way
that we fund military defense. It needs to be UM,
it needs to be completely ramped up. It needs to
include um A massive lessons learned. When this is all
over and I think UM moreover, it's it's inexplicable to
(27:20):
me why we haven't been able to act on some
of the major recommendations that have come out of out
of exercises throughout the last several months and years. So
when you dig deep and try to understand it, what
conclusions do you draw? I draw a couple m One
is that it's really hard to imagine a scenario on
the scale of what's happening now, and so we've developed
(27:43):
many tools over the last couple of decades to help
us with pandemic threats. One is our Strategic National Stockpile,
which has been in the news a lot lately. Another
is the Global Health Security Agenda, which is something the
Obama administration launched to assist other countries to get prepared.
Both of those efforts, just as in another is our
Biomedical Research and Development Agency bar TO, which helps advance
(28:07):
medical countermeasures. These are massive efforts that different presidents launched
which when we look at them in retrospect, made a
huge difference in our ability to deal with this crisis,
but didn't go nearly far enough. And so I think
part of it is when you look at the reports
written about nine eleven, it's a failure of imagination, not
to imagine what could happen, we're pretty good at that
(28:29):
and tabletop exercises, but to actually get past the imagining
and into the filling of the major gaps that will
have to deal with in the worst case scenario. And
I think that's been challenging for for many leaders to
wrap their heads around, including me when I was in government.
But I also think that it's a it's a failure
of of not having enough people in government whose day
(28:52):
to day job it is to be thinking about those gaps.
I put out a note to doctors, ner, his respiratory therapist, etcetera,
to tell me about what they were experiencing, and it's heartbreaking.
I just got a message this morning from someone who
is a doctor in Louisiana who's already lost several colleagues
(29:16):
to the coronavirus. Who can who's writing her will? I mean,
it's just heartbreaking to me. These young people who are
working so hard on the front lines. And I don't
want this to be a Kulda would have should have,
But there has to be some lessons learned. I hope
there's a commission similar to the nine eleven commission to
(29:38):
look back on this. But what could have been done
to provide to our most critically important healthcare professionals the
protective equipment they needed? How could we have supported these
people more and protected them? I think it's a It's
(29:58):
an excellent question, the hardest question to answer. I think
right now, UM, it's very clear that we needed a
much more nationalized response than we currently have. And UM,
I think going back a couple of months, we should
have been thinking forward about that nationalized response. So what
I mean by that is, right now, we're seeing reports
(30:20):
and I'm hearing them to talking to mayor's offices and
people who are out on the front lines in the field,
and they're cannibalizing each other. They're trying to buy equipment,
um over top of each other. And the problem is
that we have a system in the United States for
responding to a pandemic that is built on what the
(30:42):
states will request, and that that's still the system that
the federal government seems to be building its response off of.
And this isn't a hurricane. Hurricanes are hugely devastating, but
they usually don't affect all fifty states at once, and
usually they don't continue for months and months and months UM.
And so our system is built for providing and scaling
(31:05):
up specific commodities and then getting them out quickly to
the field, but not ramping up production continually for all
fifty states. And so it's really it's clear to me,
at least at this moment, that we need someone in
charge of the National Logistics Response UM, working with FEMA
or maybe from within FEMA, but planning this the way
(31:27):
we do a massive military operation. I don't mean to
militarize the response in that sense, but using those tools
that we have to transport, produce, and supply our country.
And it doesn't seem like we've kicked that into high gear,
nor that we were planning to do that a couple
of months ago, when it would have made a much
bigger impact. So what's the solution now? I mean, these
(31:49):
people are desperate, they're reusing these and mass they're trying
to sanitize them. They don't have the equipment they need.
How the heck do we get this equipment to these
people pronto? So I see two solutions and two and
neither of them are perfect and neither of them are
fast enough. But solution number one is that we UM,
(32:11):
we have a national registry that starts monitoring where all
the pp is and brings together all of these great
um blooming initiatives that are happening out in the field
under an umbrella that can actually match make much more
effectively between states and entities that need personal protective equipment
(32:32):
and other supplies the most. And that would require a
real nationalized response with the logistics plan and someone in
charge of it who knows how to plan, you know,
on the order of a military operation, somebody like the
head of trans Calm who does this for a living.
When we UM, when we have a massive operation overseas.
(32:52):
The other option, UM, if that can't happen, or won't happen,
or isn't agreed to happen, is that the governors could
UM come together and decide to do this themselves. UM.
They could work with UM a coordinator on their own.
They could work with the private sector with Amazon and
you know ups and others who have logistics chains themselves
(33:16):
to create a more nationalized system across the fifty States.
UM and I I've talked to a few people about
that idea, almost an air traffic controller concept for the
for the response, and I think that it's something that
could work, but it would really need the right person
in agreement from the States to do it. The other
thing that really makes me frustrated right now looking at
(33:38):
the response is that ideally, UM, what we do, what
the United States of America does, is we lead the
global response, and we're not right now, and we should
be making enough to staff and stock our own country,
and then we should be shipping it and coordinating the
response all over the world. And right now we're one
of the only countries in the world that can actually
(34:00):
do that, even though it's hard to see that we
can at this moment, we have the capability, the logistics capability,
of production and manufacturing capability to do that, and we're not.
We should make too many and then we should staff
the global response. We'll return with Beth Cameron after the
short break. We're back with Beth Cameron, who ran the
(34:36):
White House Pandemic Office from two thousand sixteen until March
of two thousand seventeen. A year later, the Trump administration
disbanded the office, a move that she says left the
country less prepared for pandemics like COVID nineteen. What about
these tests, um and the CDC? I mean, did the
(35:00):
CDC just royally screw up? I hate to be so
blunt about this, but did the CDC all down on
the job? What happened with these this whole testing thing?
Why weren't there enough? And why are there still not enough?
I think there are a couple of failures on the
testing front um, and I've done some forensics on this, um,
(35:23):
there are other people that have to I actually lay
the criticism for this not directly at CDC s feed,
although certainly there were some challenges at CDC in this
as well. I lay it at the feet of leadership
because honestly, UM, when CDC realized that their test kit
was going to have problems, M yes, someone should have
(35:43):
sent a flare up saying, hey, we have problems, let's
have a backup, let's order the w h O kits,
let's put them through emergency use authorization so we can
do that. But somebody else at HHS in the government
at the White House, UM, in leadership position should have said, look,
while you're working on this test and perfecting it, we
(36:04):
are going to create a backup because it is too
important that we start testing now. Um. That's not necessarily
the job of the people manufacturing the test kit at CDC.
It's their job to alert, but it's somebody else's job
to say, Okay, we're going to make the decision for
you that this isn't the only test that we're going
to have. And that's the kind of decision that the President,
(36:27):
the Vice President, you know, the lead for this UH
for this pandemic in the White House should be bugging
every day about so. And to go full circle bath,
that's the kind of issue this Pandemic Commission would have
been all over and on top of, because it would
have been part of its centralized role to make sure
(36:49):
that you know, these things were taken care of in
a in a very efficient, fast way. That's that was
exactly the reason that the office was created to be
able to get above the day to day challenges that
people were facing, which are sometimes really hard to surface.
As you know, when there's a problem, it's really hard
for people at the working level to admit that the
(37:11):
problem is great, especially if it's a problem that they
don't usually experience. CDC is usually quite good at creating
excellent test kits um and diagnostics. When they have a problem,
somebody should say, look, you're having a problem. That's okay,
We're going to help you solve the problem. But we
can't wait for you. Um. That's that's leadership's job. And finally, Beth,
(37:33):
there's been some rumblings and indication that the administration is
weighing the cost on the economy with the cost on
public health and and and human life. Really uh, that
there's some drive in the White House, ostensibly led by
(37:55):
the President himself, to try to take a look a
couple of weeks to returning or making efforts to loosen
the guidelines and mandates and to get the economy going again.
So I think Easter Sunday and you'll have packed churches
all over a country. I think it would be a
(38:17):
beautiful time. And it's just about the timeline that I
think is right. This is against the advice of I
think universal advice of public health advocates and officials and experts. Um,
can you weigh in on the rumplings we're hearing about that.
I don't even think it's just the public health experts.
(38:39):
I think it's every credible person that I've talked to. UM,
we can't relax these measures, and it would be bad
actually for the economy. I mean, if we weren't even
thinking about the huge toll on lives and the at
risk and the elderly, if we even put that aside
for a second, this would be bad for the economy
because until the case load comes down, until our hospitals
(39:00):
system stabilizes, until we have a steady supply chain for
all of the things we've been talking about, personal protective equipment,
UM and re agents, test kits, etcetera. Until all of
those things get to a stable level. If we turn
people back on and send them back to work, where
we'll see increasing spikes crashing health care system, people will
(39:22):
then not go to work, or they'll be sick, they'll
be confusion, and ultimately the economy will tank again. And
it might even be it might I'm not an economist,
but I surmise it might be worse because it will
be even more unpredictable how that will happen across the country.
So I think it would be a terrible idea to
relax these measures right now when they're actually starting to
(39:43):
make a difference. There does need to be hope, though, um,
for the American public and for the economy. And I
think that hope is letting the social distancing do its job,
watching the case counts start to fall the way that
they've fallen in other countries that have done this, and
then ma of testing so that we know who is
infected and ultimately also who has been infected, so that
(40:07):
people can be isolated on a case by case basis,
and the people that don't have the disease or who
have recovered from it can start getting back to work.
And I think that's what we have to be looking for,
and we have to have um specific fact based measures
that drive us in that direction. But we're definitely not
there yet. It's fascinating to the science of this virus
(40:29):
is so complex, um, And are you optimistic that that
the scientists studying this, that that are working so hard
on developing a vaccine, who are trying to identify the
antibodies that some people have naturally to this virus, that
that science will come up with some answers relatively soon.
(40:54):
I'm optimistic, um, for sure that we're going to get there.
I think most of the experts I trust, including folks
that are out at the Coalition for Epidemic Preparedness Innovation,
which has been looking at coronaviruses and vaccine candidates for
coronaviruses for a while now. I'm optimistic that will eventually
get a vaccine, but it will probably be twelve to
(41:14):
eighteen months. I am optimistic that will eventually get to
some therapeutics that might work for some individuals, and hopefully
we'll get to some therapeutics that work for the elderly
and for other at risk populations, because that's where if
we can if we can help identify a few things
that work, um, that would be even just to make
(41:34):
it less less deadly, even if it's still has a
terrible course in some people. UM, I think that would
be helpful. I am optimistic, um, but I think we're
in this for for months um until that point, and
certainly at least a year for a vaccine. Well. Hopefully
this terrible chapter in our history and and the world's
(41:55):
history will provide some lessons learned. I have to believe
that we will look back and try to get a
handle on how we prevent this from happening in the future.
That was Beth Cameron, currently the Vice president for Global
(42:17):
Biological Policy and Programs at the Nuclear Threat Initiative. And
that does it for this episode of Next Question. I
know a lot of this can be tough to hear.
These are indeed scary times, but if we do our part,
if we heed the experts warnings and stay home and
(42:39):
find virtual ways to connect, we can get through this.
In the meantime, to lighten the load, I'd like to
highlight an act of kindness. You might remember last week
I asked you to share the good deeds you've seen
or experienced during these dark times, and we've gotten some
really touching ones. I'd like to share one message I
(42:59):
received from a listener named Lee Stewart, who lives in Bristol, Virginia.
A couple of days ago, my brother and I had
to leave our eighty nine year old mother alone in
the I see you of the local hospital because it
had to ban visitation due to the coronavirus. Of course,
(43:22):
we totally agree with the precautions, and even she understood
that they were necessary. But it's so difficult, especially when
right before I left, she clasped my hand and said,
I don't want you to leave me. However, her nurses
have been absolute angels. They have adopted her and even
(43:48):
fixed the face time on her phone so that my
brother and I can chat with her. So every afternoon
one of the nurses holds up the phone own and
calls us and we're able to have a nice long
talk with our mom and just really see how she's doing,
(44:10):
and she can see us. That gives her a lot
of comfort. Um, we can't even describe how grateful we
are for these medical professionals who are not only using
their medical knowledge on the front lines of this crisis,
but who also are providing a conduit of compassion that
(44:37):
enables families like ours to stay together, even though it
times that's only in a virtual way. Thanks for your
hard work and inspiration during this crisis, and thanks so
much to the our ends and other medical staff who
(44:59):
are both warriors and angels during this time. Thank you, Lee.
We wish you and your family well, and of course
the same to all of our listeners. You can keep
sending your moments of kindness. I think we could all
use a dose of the fields. Just leave your name
and a detailed message at eight four four four seven
(45:22):
nine seven eight eight three again eight four four four
seven nine seven eight eight three. You can also email
me at info at Katie Kirk dot com. Just put
kindness in the headline. For the most up to date
information and guidance on the coronavirus pandemic, please visit the
(45:42):
CDC and the World Health Organization. You can also check
out our morning newsletter, wake Up Call. You can subscribe
to that and get everything you need to know every
morning in your inbox. Just go to Katie Kurk dot com.
We'll be continuing this special coronavirus coverage on Next Question
Him for the weeks to come. You can subscribe to
(46:02):
us on Apple podcast, the I Heart Radio app, or
wherever you listen to your favorite shows. Until next time
and my Next Question, I'm Katie Couric. Thank you so
much for listening, and stay safe everyone. Next Question with
(46:28):
Katie Couric is a production of I Heart Radio and
Katie Currik Media. The executive producers are Katie Kurik, Courtney Litz,
and Tyler Klang. The supervising producer is Lauren Hansen. Our
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(46:53):
Gabriel Loser. For more information on today's episode, go to
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heart Radio, visit the I heart Radio app, Apple podcast,
or wherever you listen to your favorite shows
Hi everyone, I'm Katie Kuric, and welcome to next question. Today,
we once again are dedicating our full attention to the
coronavirus pandemic, which continues to spread across the country, growing
at alarming rates in the most populated areas. In fact,
on Friday, March, the Mayor of New York City, Bill
(00:21):
de Blasio, marked a distressing new milestone. I hate to
say this, but it's true. We are now the epicenter
of this crisis. New York State has nearly half of
the nation's coronavirus cases, and the number is growing faster
than anyone predicted. As of this recording, the positive COVID
(00:42):
nineteen count in New York City is doubling every three days.
Here's Governor Andrew Cuomo. On March, one of the forecasters
said to me, we were looking at a freight train
coming across the country. We're now looking at a bullet train,
because then numbers are going up that quickly. What that
(01:02):
means is that the peak of coronavirus infections will be
much higher and hit New York much sooner than expected.
Giving the city's vast network of hospitals, which are already
under tremendous strain, less time to prepare, less time to
get the critical equipment they need to care for those patients,
and less time to replenish their stash a protective gear
(01:25):
so that medical staff can continue to work without getting sick,
Which leads to my next question, how are emergency rooms
in New York City faring now? And how are they
bracing for what's to come? And later on what could
have been done to allow us to be better prepared
(01:46):
for this pandemic. But first, Hi, rob Hi, Hi, it's Katie.
How are you? How are you doing? Oh? My god?
Thank you for taking time to do. Dr Robert Semia
is the Chair of Emergency Medicine IT and y you
Land Gown in New York City. In that role, he's
(02:07):
in charge of the emergency departments of several n y
U hospitals across the metropolitan area. We see about five
thousand patients in all of our emergency departments across Manhattan, Brooklyn,
and Long Island, and we've seen a couple of consistent things.
One Overall, at the majority of our emergency departments, the
(02:30):
volume is down, but we have a huge spike in
the number of respiratory cases that are serious requiring requiring intubation,
and that numbers seems to be growing every day. I
get a I get a report every twelve hours from
our emergency departments Shift report one of our a d s. Yesterday,
in a twelve hour period intubated seven patients had put
(02:54):
them on ventilators. That's a huge number for one twelve
hour period of time. And then you know we have
very The next day might be one or two. The
next day it might be six or seven again, so
there's capacity right now, but everyone's trying to figure out
how do you make sure that there's capacity down the road.
To help with some of this, we stood up a
(03:16):
twenty four hour a day video visit telemedicine, where now
we're seeing a thousand visits on a telemedicine platform trying
to keep people off the subways from spreading disease, giving
them advice, and keeping them out of the emergency departments.
So we have seen some good impact there where our
(03:37):
overall eat volume is down for people that are not
seriously ill, but we have seen a huge spike in
the number of people who are very sick and needing
to be put on ventilators. Well, let's first talk about
the telemedicine patients rob you're seeing. Basically, they need to
know if their symptoms are serious enough to go to
the hospital, if they in fact have COVID nineteen. In
(04:00):
most of those cases, are you able to encourage them
to in fact stay at home and to self quarantine.
We have. One of the things that the telemedicine visits
that we're seeing is that there's a lot of public
fear and it's grounded in in really a lack of information,
(04:20):
and so we're seeing many patients who really have a
couple of questions. One, they want to know if they're
going to get seriously ill suddenly and die. Number two,
they want to know if they need a test for COVID.
And number three they want to know, Okay, what symptoms
do I watch for if I quarantine at home. When
someone calls you, particularly an elderly person, and worries that
(04:44):
that person is going to be come extremely ill from this,
what do you tell them? The majority of calls that
we're seeing are from people that are younger that have
symptoms that most of us, if it wasn't this pandemic,
would think our typical winter rest the tory colts, low
grade fever, cough um right, no sore throat. The issue
(05:06):
is that those symptoms overlap with the same symptoms as
COVID and UM. What I tell patients is that most
of us will probably are many of us will probably
get COVID and UM not even realize that. We'll just
think at the winter cold and the majority of us
will do just fine. UM. And really the people that
need to go to the e r s are those
(05:27):
who have those typical resttory symptoms and then those symptoms
progress to UM shortness of breath and difficulty in breathing,
and so we give them advice about that, and we
also talk about the need for testing. And for most patients,
what we tell them is, you know, if your symptoms
are in that minimal group right now, you're not having
shortness of breath. Whether you have a COVID test or not,
(05:50):
does not change the information and the guidance that I'm
going to give you right now, which is to stay
at home self quarantine um UH. Go to the CDC
or the government websites. UM. If you're unsure about the
best way to self quarantine at home. We usually tell
people you should do things like if you share a
bedroom with someone, to sleep in a separate bedroom, if
(06:11):
you have a second bathroom, try to use that bathroom,
do good disinfection of counter surfaces, and those things. And
then we give them guidance about what you need to
watch for, and that being the increasing shortness of breath
and for those patients, you should come to the emergency department.
Most people are pretty relieved when they hear that because
(06:31):
they're just not sure. The experience that we're seeing in
the emergency department is that the majority of the patients
that are ending up on rest but on ventilators are elderly,
but we are seeing people in younger age groups that
are very sick. Also. I'll tell you what's been the
uplift thing part of these conversations is that we're seeing
(06:52):
many people that are younger generations that are sick, and
they're telling me, you know, I don't want to go
out and potentially infect older people, and I don't want
my grandmother and my grandparents to be at risk, and
so um, that part has been very uplifting to to hear.
So it's that's positive because we've seen so many stories
(07:13):
rob of of kids going on spring break and being irresponsible.
So it's nice to hear that younger people are actually
thinking otherwise than trying to be more responsible. Let's talk
about personal protective equipment or PPE, a word that the
general population now understands that used to be the purview
of the medical community. We're talking about the mass, the gowns,
(07:36):
the gloves that protect you and your team from coronavirus. UM.
Are you all getting the equipment you need? There's not
enough and UM we have the equipment now, but we're
worried that UM, as is everybody that will run out,
and so we started conservation measures that are safe, but
(08:00):
they're psychologically taxing on the doctors and nurses at work.
So UM. Some of the things that we've done UM
are to cohort any patient that comes into emergency departments
into just one area of the e er. Whereas before
all this happened, you you know, we have multiple teams
and we have big emergency departments, and you could go
(08:22):
to any part of the emergency department. Now we we
put all the patients in one area that have those symptoms,
and in that area are doctors and nurses where those
and nine masks that you're probably hearing about and those
masks are in short supply. And and how those masks
help is they help with airborne or or virus that's
(08:44):
floating in the air, and typically they're used for tuberculosis
or things like that. COVID appears to be mostly droplets,
so somebody sneezes on you, costs on you. Those that
liquid hits you, um and doesn't really hang in the air,
but there are some indications that for certain things it
does hang in the air, like when we're doing an
intubation or those things. So, UM, what we've had to
(09:05):
do is to somewhat limit how many times we change
out of that equipment, so you might wear your same
mask with a face shield, for example, on the entire shift,
instead of changing it multiple times to shift. We do
change our gowns and other things. Or if we get sprayed,
(09:26):
of course we change. But that's something that we never
had to do. We never had to worry about conservation
and UM, to an im introom doctor or nurse, it's
it's an emotional drain. Um. You're already in a in
a and basically a space suit that you can only
(09:48):
change up part of it. You're hot, you're sweaty. Yeah,
everybody's concerned that. You know, can the supply and chain
catch ups? Anybody who works with you have any of
your colleagues got sick? Yes, Um, so many of our
people have gone sick. Doctors and nurses with fevers or costs.
(10:10):
We they all get sent home. When COVID testing was available,
they were tested, some of them positive, some negative. The
good news is all of all of our people who
actually have been positive and sick are all better and
return to work. Now we've done some things. We do
have some more senior physicians. We've kept them uh in
(10:34):
parts of the emergency department where they're not exposed, you know,
just knowing that that most people that have a little
more candles on their birthday cake are more at risk.
But no, the good news is is at n y
U Land going here, every every one of our doctors
and nurses that's gotten sick has recovered us fine. I
want to bring up a question from a listener. Her
(10:55):
name is Mary, she's a nurse. She doesn't say where
she works, but she wondered if how care workers should
isolate themselves from their families. I'm assuming even if they're
asymptomatic if and if so, how have you gotten such
a question yourself? What are you advising your colleagues to do? So?
One of the things is that, UM, you know, just
(11:18):
like the general public. UM. You know, our colleagues and
the emergency departments UM here in New York and across
the country come to work every day. But everybody has
their own anxieties about this, and so for example, UM,
we've created the ability for people to shower before they
actually go home because they're wondering, am I going to
(11:39):
spread something? Am I an asymptomatic career? I have people
that I work with who have decided they have a
little baby at home, and with their seeing they pan
out there that they're not going to go home, They've
got a friend's place to stay at, who has a
vacant apartment, of those kind of things. All those questions
we run we run by our infection disease specialists. But
I think you know a lot of people, even when
(12:01):
they're doing the best practices at home, whether that's trying
to keep a distance, even though they may not have
any UM symptoms, they're still wondering. They're still worried for
themselves and their word, for their family, and so they're
taking whether it's appropriate, precautions, extra precautions. Yeah, people worry
about those things and they try to keep some distance. UM.
(12:23):
When I do these videos is it's also sides working
in the dy we do get people. Another group that
we're concerned about is if you live with somebody who's
immuno compromised. You know, I've had people tell, you know,
talk to me saying, you know, they can't get COVID
testing as of today. Um. That seems to be constantly
(12:44):
changing the availability of public testing. They're concerned because someone
they live with has multiple miloma or some form of cancer.
They're aware that those people are at an increase risk,
and so they want to do the right thing. Try
to keep their distance, try to socially isolate, but try
to do that while you're sharing a home with somebody.
(13:04):
I had people tell me they're living in their basement
if they have a basement. Um. So there's a lot
going on, um as people try to keep each other
as safe as possible. When you think about the next
few weeks, do you have any idea when this is
going to peak? No idea, I don't you know, I
(13:25):
don't know. UM, you know, it's hard hard to say, UM,
I'm seeing sicker patients and in increasing numbers. I don't
know when that will level off. Our general approach is
that we need to be prepared for this to be
a marathon and not a sprint, and so making sure
(13:45):
that our doctors and nurses get adequate respite, making sure
that we have relief physicians and nurses available should it,
should much of the workforce go down temporarily or have
to go home because they're sick. For approaches, UM do
our best on a day to day basis, but our
eyes looking down the road always tell people that you know,
(14:06):
working in an emergency department on a regular day is
like running a two minute no huddle offense in football,
but for eight hours. And now you throw in, UM,
some uncertainty into that mix. It's it's like you're trying
to do that in a swimming pool. But UM, people
that work in emergency departments are special. They have big hearts,
(14:29):
They feel for patients and human suffering, and UM are
really up for this challenge and and just want to know.
I just want to feel that their support for them,
and that support looks like proper ppe and UM, I
will tell you that doing some of these videos. Its
(14:50):
also has been uplifting because so many times people have
expressed gratitude for what e R doctors and nurses do.
We're getting more thank you than we normally do. We're
seeing young people talk about how they're worried about older folks,
and there's this multigenerational kind of commitment and kindness and
(15:12):
empathy that's on display. So, UM, yeah, you know, we're
all as a nation going through a lot, and we're
all in this together. But I've seen some really encouraging
signs of um, what the future looks like and um
seeing a lot of people's in her kindness right to
(15:33):
the surface, and that makes me feel really good. That
was Dr Robert Famiett, Chair of Emergency Medicine at and
why you land gone in New York City and why
you may be managing now, but other hospitals around New
York City and indeed the country are already struggling under
the pressure of the coronavirus and the weeks to come.
(15:55):
I'll be continuing to reach out to those working on
the front lines of this pandemic, and I'll bring you
those stories here on this podcast, also on Instagram. Live,
which you can find by searching my name Katie Curic
on Instagram. Up next, why wasn't this country better prepared?
We'll talk with an expert whose job was to do
(16:18):
just that. Welcome back, everyone. We're continuing our coverage of
the coronavirus this week, taking a look at pandemic preparedness
(16:42):
from the emergency room to the oval office. Hi, fa Hi,
thanks so much for doing this. Beth Cameron is the
former Senior Director for Global Health Security and Bio Defense.
This unit, which was a part of the White House
National Security Council, was established by the Obama administration after
the two thousand fourteen Ebola epidemic, and it was intended
(17:06):
to be a smoke alarm, a warning of the first
signs of a global health crisis. In two thousand eighteen, however,
the Trump administration disbanded the unit. The Office of Global
Health Security and Bio Defense was set up after the
Ebola epidemic in order to get ahead of outbreaks before
they become epidemics or pandemics. We're really worried coming out
(17:29):
of Ebola. It was a hugely devastating outbreak that killed
over eleven thousand people. UM, but we were looking at
that as ultimately an event that stayed relatively circumscribed to
three major countries. Of course, there were lots of concerns
that it would spread more rapidly, and there was a
huge global intervention that the US helped lead to keep
that from happening. But we were very worried about exactly
(17:52):
what we're seeing now, a large scale respiratory illness that
would become a pandemic, and we knew that we weren't
prepared for that as a nation or as a world.
Let's imagine a world in which that office had not
been dissolved and you were still leading at Beath. What
role would it be playing right now in the midst
(18:12):
of this crisis. It would really be the best way
to describe the office's role now would be as a
coordinating hub. So the office was playing a role in
in working with high level senior officials and sending information
about problems and issues up the chain so that they
would be resolved quickly. But also really importantly, we're listening
(18:34):
to staff at the working level across departments and agencies.
So when there was a problem or a challenge or
a need in the States or in another country. We
were able to figure out, Hey, what's the real issue,
who's not agreeing, and then elevate it really quickly. You
helped transition the incoming Trump administration. You directly briefed then
(18:57):
Homeless Security Advisor Tom Bossard. Did you have a sense
at that time the new administration was committed to the
objectives of this office. Yes, during the transition, I had
quite a good experience with transitioning this specific office from
President Obama to President Trump, and both the outgoing team
(19:19):
and the incoming team, particularly as you mentioned, Homeland Security
Advisor Tom Basser had been through um pandemic threats before
in the Bush administration, and so there's actually quite a
lot of support for continuing the role of this office,
and not only from Tom Basser, but also from National
Security Advisor HR McMaster, who I briefed before I left.
(19:40):
You said you were mystified when the Trump administration dissolved
the office in May of two thousand eighteen. Now there
seems to be a difference of opinion here with your
op ed in the Washington Post and someone within the
Trump administration name Tim Morrison, who believes that your account
was wrong. So tell me as you understand it. What happened?
(20:03):
Can you explain? I can, and and I think that
Tim's op ed was less of a rebuttal of what
I said and more of an explanation of the organizational
structure UM and what happened. So my understanding of what
happened is that Tim Zeemer, who took my position as
the head of the Office UM, left the White House
and the people who worked on his team were dissolved
(20:27):
and were moved into another director at the director that
Tim Morrison ran. And it's definitely true that some good
policies did come out of that office following the dissolution
of the pandemics team. But the difference, the critical difference,
is that there wasn't a team or a senior level
(20:47):
person whose only responsibility it was to handle pandemic threats.
And that was something that coming out of the BOWLA
Epidemic re realized was missing. That we were all focused
on epidemic, we were all focused on the BOWLA outbreak,
but we didn't have a singular mission with a direct
reporting line to the National and Homeland Security Advisor where
(21:08):
our job was only to focus on that issue. And
it's like a transnational threat like counter terrorism um, like
climate change, it's something that when we see what's happening now,
it's easy to understand why you'd want to have a
singularly focused pandemics team. But when you don't have a
pandemic happening, I can see how it would how a
(21:29):
national security advisor might look at that and think, well,
maybe we don't need a team that's solely focused on
this issue, and I just completely disagree with that. This
is a lesson that lots of administrations have learned. So
there have been senior level officials in the last couple
of administrations focused on pandemic threats, and usually it's after
an outbreak or a pandemic when that lesson um is learned.
(21:51):
And so one of the things that happened in the
Obama administration is a couple of lessons came together. One
of those lessons was that we needed a senior level
official who's only job it was with a direct reporting
line to leadership. The other lesson is that we needed
a team that looked at homeland and national security issues together.
When President Trump was asked about this Beth during one
(22:12):
of the White House press conferences, he insisted he didn't
know anything about that, But you did disband the White
House Pandemic Office, and the officials that were working in
that office left this administration abruptly, So what responsibility do
you take to that? And the officials that worked in
that office said that you that the White House lost
valuable time because that office wasn't disbanded. What do you
(22:33):
make of that? Well, I just think it's a nasty
question we've done. Were you surprised at that and who
exactly was in charge of getting rid of the position?
I was surprised by that. Um. I was surprised because
there was quite a lot of press about getting rid
of the office in when it happened, and there were,
you know, a number of high level people in Congress,
(22:56):
UM think tanks who wrote letters or spoke out and
said that this was a mistake. So I was surprised
that he wasn't aware. Um. The all I can say
is that the dissolution of the office happened around the
same time that Tom Bosser left, so right after he
left and right as National Security Advisor John Bolton came
on board, and so I think this really was part
(23:18):
of an overall restructuring and a decision was made that
this reorganization was a was a better organization for the
White House. The White House is to choose its organizational structure.
But it's unfortunate that this lesson got unlearned in the process.
Let's talk about some of the warning signs though, that
existed for this current epidemic pandemic. Rather, can you talk
(23:41):
about some of the flashing red lights that we saw
because there were a number of them, weren't there. Yeah,
there were a number of them. Um, you know, going
back to the beginning and watching the outbreak unfold in China,
looking at a novel coronavirus that had um the ability
(24:01):
to spread between people. That was definitely something in our
playbook of concerns, you know, a new disease that could
spread more quickly between people with with a higher mortality.
And I think the second that that information became available,
that would have flipped a switch for us to start
meeting more regularly and thinking about what kinds of what
(24:23):
kinds of preparedness plans we needed to put in place
or dust off in the United States. And when was that?
That was in January when those cases really started coming
coming to light. There was absolutely a bit of a
delay in the world learning about this, But we did
learn about it um in January, UM, several months ago.
I want to mention something even prior to that. According
(24:45):
to The New York Times, there was a training exercise
led by multiple federal agencies, twelve states, and private stakeholders
that simulated a scenario where respiratory virus dubbed the crimson
can tajun rapidly spread through the United States. What can
you tell us about that, because before we talk about
(25:07):
January February, let's talk about October. Yeah, well, we can
go back even further than than October. We can go
back to the transition between the administrations. So back in January,
before the Obama administration left, there was a half day
um discussion between the outgoing cabinet, the outgoing White House leadership,
(25:29):
and the incoming team, the presumptive nominees for the Trump administration,
And we looked at a number of homeland threats and
one of the small number of things highlighted for the
incoming team was pandemic was pandemics. So I was in
that discussion and helped put that that discussion together, and
there was a very robust conversation between outgoing officials and
(25:51):
incoming officials about a respiratory agent um in that place,
I think we were looking at a flu variant that
could do something very similar to what's happening now. And
then fast forward to a number of tabletops that happened
outside of government, as well as the one highlighted in
the New York Times, which actually I was not aware
of that exercise and wasn't in government when it was conducted,
(26:14):
but reading the reports of it, it looks eerily similar
to what's happening now and certainly is something that White
House leadership should and would have been aware of. So
why do you think they didn't pay attention to that?
I mean, the serendipity of that simulation is pretty uncanny.
I think a couple of things, just having gone through
(26:36):
these exercises, they can they can based on who's in
charge of of acting on what comes out. They either
become playbooks for action and urgent action, or they become
overwhelming and people don't know where to start to fill.
What is apparent now to us in the world is
just a massive, massive set of gaps in pandemic preparedness.
(26:58):
So um, all I can say is that this was this,
this issue of pandemic preparedness should be funded the way
that we fund military defense. It needs to be UM,
it needs to be completely ramped up. It needs to
include um A massive lessons learned. When this is all
over and I think UM moreover, it's it's inexplicable to
(27:20):
me why we haven't been able to act on some
of the major recommendations that have come out of out
of exercises throughout the last several months and years. So
when you dig deep and try to understand it, what
conclusions do you draw? I draw a couple m One
is that it's really hard to imagine a scenario on
the scale of what's happening now, and so we've developed
(27:43):
many tools over the last couple of decades to help
us with pandemic threats. One is our Strategic National Stockpile,
which has been in the news a lot lately. Another
is the Global Health Security Agenda, which is something the
Obama administration launched to assist other countries to get prepared.
Both of those efforts, just as in another is our
Biomedical Research and Development Agency bar TO, which helps advance
(28:07):
medical countermeasures. These are massive efforts that different presidents launched
which when we look at them in retrospect, made a
huge difference in our ability to deal with this crisis,
but didn't go nearly far enough. And so I think
part of it is when you look at the reports
written about nine eleven, it's a failure of imagination, not
to imagine what could happen, we're pretty good at that
(28:29):
and tabletop exercises, but to actually get past the imagining
and into the filling of the major gaps that will
have to deal with in the worst case scenario. And
I think that's been challenging for for many leaders to
wrap their heads around, including me when I was in government.
But I also think that it's a it's a failure
of of not having enough people in government whose day
(28:52):
to day job it is to be thinking about those gaps.
I put out a note to doctors, ner, his respiratory therapist, etcetera,
to tell me about what they were experiencing, and it's heartbreaking.
I just got a message this morning from someone who
is a doctor in Louisiana who's already lost several colleagues
(29:16):
to the coronavirus. Who can who's writing her will? I mean,
it's just heartbreaking to me. These young people who are
working so hard on the front lines. And I don't
want this to be a Kulda would have should have,
But there has to be some lessons learned. I hope
there's a commission similar to the nine eleven commission to
(29:38):
look back on this. But what could have been done
to provide to our most critically important healthcare professionals the
protective equipment they needed? How could we have supported these
people more and protected them? I think it's a It's
(29:58):
an excellent question, the hardest question to answer. I think
right now, UM, it's very clear that we needed a
much more nationalized response than we currently have. And UM,
I think going back a couple of months, we should
have been thinking forward about that nationalized response. So what
I mean by that is, right now, we're seeing reports
(30:20):
and I'm hearing them to talking to mayor's offices and
people who are out on the front lines in the field,
and they're cannibalizing each other. They're trying to buy equipment,
um over top of each other. And the problem is
that we have a system in the United States for
responding to a pandemic that is built on what the
(30:42):
states will request, and that that's still the system that
the federal government seems to be building its response off of.
And this isn't a hurricane. Hurricanes are hugely devastating, but
they usually don't affect all fifty states at once, and
usually they don't continue for months and months and months UM.
And so our system is built for providing and scaling
(31:05):
up specific commodities and then getting them out quickly to
the field, but not ramping up production continually for all
fifty states. And so it's really it's clear to me,
at least at this moment, that we need someone in
charge of the National Logistics Response UM, working with FEMA
or maybe from within FEMA, but planning this the way
(31:27):
we do a massive military operation. I don't mean to
militarize the response in that sense, but using those tools
that we have to transport, produce, and supply our country.
And it doesn't seem like we've kicked that into high gear,
nor that we were planning to do that a couple
of months ago, when it would have made a much
bigger impact. So what's the solution now? I mean, these
(31:49):
people are desperate, they're reusing these and mass they're trying
to sanitize them. They don't have the equipment they need.
How the heck do we get this equipment to these
people pronto? So I see two solutions and two and
neither of them are perfect and neither of them are
fast enough. But solution number one is that we UM,
(32:11):
we have a national registry that starts monitoring where all
the pp is and brings together all of these great
um blooming initiatives that are happening out in the field
under an umbrella that can actually match make much more
effectively between states and entities that need personal protective equipment
(32:32):
and other supplies the most. And that would require a
real nationalized response with the logistics plan and someone in
charge of it who knows how to plan, you know,
on the order of a military operation, somebody like the
head of trans Calm who does this for a living.
When we UM, when we have a massive operation overseas.
(32:52):
The other option, UM, if that can't happen, or won't happen,
or isn't agreed to happen, is that the governors could
UM come together and decide to do this themselves. UM.
They could work with UM a coordinator on their own.
They could work with the private sector with Amazon and
you know ups and others who have logistics chains themselves
(33:16):
to create a more nationalized system across the fifty States.
UM and I I've talked to a few people about
that idea, almost an air traffic controller concept for the
for the response, and I think that it's something that
could work, but it would really need the right person
in agreement from the States to do it. The other
thing that really makes me frustrated right now looking at
(33:38):
the response is that ideally, UM, what we do, what
the United States of America does, is we lead the
global response, and we're not right now, and we should
be making enough to staff and stock our own country,
and then we should be shipping it and coordinating the
response all over the world. And right now we're one
of the only countries in the world that can actually
(34:00):
do that, even though it's hard to see that we
can at this moment, we have the capability, the logistics capability,
of production and manufacturing capability to do that, and we're not.
We should make too many and then we should staff
the global response. We'll return with Beth Cameron after the
short break. We're back with Beth Cameron, who ran the
(34:36):
White House Pandemic Office from two thousand sixteen until March
of two thousand seventeen. A year later, the Trump administration
disbanded the office, a move that she says left the
country less prepared for pandemics like COVID nineteen. What about
these tests, um and the CDC? I mean, did the
(35:00):
CDC just royally screw up? I hate to be so
blunt about this, but did the CDC all down on
the job? What happened with these this whole testing thing?
Why weren't there enough? And why are there still not enough?
I think there are a couple of failures on the
testing front um, and I've done some forensics on this, um,
(35:23):
there are other people that have to I actually lay
the criticism for this not directly at CDC s feed,
although certainly there were some challenges at CDC in this
as well. I lay it at the feet of leadership
because honestly, UM, when CDC realized that their test kit
was going to have problems, M yes, someone should have
(35:43):
sent a flare up saying, hey, we have problems, let's
have a backup, let's order the w h O kits,
let's put them through emergency use authorization so we can
do that. But somebody else at HHS in the government
at the White House, UM, in leadership position should have said, look,
while you're working on this test and perfecting it, we
(36:04):
are going to create a backup because it is too
important that we start testing now. Um. That's not necessarily
the job of the people manufacturing the test kit at CDC.
It's their job to alert, but it's somebody else's job
to say, Okay, we're going to make the decision for
you that this isn't the only test that we're going
to have. And that's the kind of decision that the President,
(36:27):
the Vice President, you know, the lead for this UH
for this pandemic in the White House should be bugging
every day about so. And to go full circle bath,
that's the kind of issue this Pandemic Commission would have
been all over and on top of, because it would
have been part of its centralized role to make sure
(36:49):
that you know, these things were taken care of in
a in a very efficient, fast way. That's that was
exactly the reason that the office was created to be
able to get above the day to day challenges that
people were facing, which are sometimes really hard to surface.
As you know, when there's a problem, it's really hard
for people at the working level to admit that the
(37:11):
problem is great, especially if it's a problem that they
don't usually experience. CDC is usually quite good at creating
excellent test kits um and diagnostics. When they have a problem,
somebody should say, look, you're having a problem. That's okay,
We're going to help you solve the problem. But we
can't wait for you. Um. That's that's leadership's job. And finally, Beth,
(37:33):
there's been some rumblings and indication that the administration is
weighing the cost on the economy with the cost on
public health and and and human life. Really uh, that
there's some drive in the White House, ostensibly led by
(37:55):
the President himself, to try to take a look a
couple of weeks to returning or making efforts to loosen
the guidelines and mandates and to get the economy going again.
So I think Easter Sunday and you'll have packed churches
all over a country. I think it would be a
(38:17):
beautiful time. And it's just about the timeline that I
think is right. This is against the advice of I
think universal advice of public health advocates and officials and experts. Um,
can you weigh in on the rumplings we're hearing about that.
I don't even think it's just the public health experts.
(38:39):
I think it's every credible person that I've talked to. UM,
we can't relax these measures, and it would be bad
actually for the economy. I mean, if we weren't even
thinking about the huge toll on lives and the at
risk and the elderly, if we even put that aside
for a second, this would be bad for the economy
because until the case load comes down, until our hospitals
(39:00):
system stabilizes, until we have a steady supply chain for
all of the things we've been talking about, personal protective equipment,
UM and re agents, test kits, etcetera. Until all of
those things get to a stable level. If we turn
people back on and send them back to work, where
we'll see increasing spikes crashing health care system, people will
(39:22):
then not go to work, or they'll be sick, they'll
be confusion, and ultimately the economy will tank again. And
it might even be it might I'm not an economist,
but I surmise it might be worse because it will
be even more unpredictable how that will happen across the country.
So I think it would be a terrible idea to
relax these measures right now when they're actually starting to
(39:43):
make a difference. There does need to be hope, though, um,
for the American public and for the economy. And I
think that hope is letting the social distancing do its job,
watching the case counts start to fall the way that
they've fallen in other countries that have done this, and
then ma of testing so that we know who is
infected and ultimately also who has been infected, so that
(40:07):
people can be isolated on a case by case basis,
and the people that don't have the disease or who
have recovered from it can start getting back to work.
And I think that's what we have to be looking for,
and we have to have um specific fact based measures
that drive us in that direction. But we're definitely not
there yet. It's fascinating to the science of this virus
(40:29):
is so complex, um, And are you optimistic that that
the scientists studying this, that that are working so hard
on developing a vaccine, who are trying to identify the
antibodies that some people have naturally to this virus, that
that science will come up with some answers relatively soon.
(40:54):
I'm optimistic, um, for sure that we're going to get there.
I think most of the experts I trust, including folks
that are out at the Coalition for Epidemic Preparedness Innovation,
which has been looking at coronaviruses and vaccine candidates for
coronaviruses for a while now. I'm optimistic that will eventually
get a vaccine, but it will probably be twelve to
(41:14):
eighteen months. I am optimistic that will eventually get to
some therapeutics that might work for some individuals, and hopefully
we'll get to some therapeutics that work for the elderly
and for other at risk populations, because that's where if
we can if we can help identify a few things
that work, um, that would be even just to make
(41:34):
it less less deadly, even if it's still has a
terrible course in some people. UM, I think that would
be helpful. I am optimistic, um, but I think we're
in this for for months um until that point, and
certainly at least a year for a vaccine. Well. Hopefully
this terrible chapter in our history and and the world's
(41:55):
history will provide some lessons learned. I have to believe
that we will look back and try to get a
handle on how we prevent this from happening in the future.
That was Beth Cameron, currently the Vice president for Global
(42:17):
Biological Policy and Programs at the Nuclear Threat Initiative. And
that does it for this episode of Next Question. I
know a lot of this can be tough to hear.
These are indeed scary times, but if we do our part,
if we heed the experts warnings and stay home and
(42:39):
find virtual ways to connect, we can get through this.
In the meantime, to lighten the load, I'd like to
highlight an act of kindness. You might remember last week
I asked you to share the good deeds you've seen
or experienced during these dark times, and we've gotten some
really touching ones. I'd like to share one message I
(42:59):
received from a listener named Lee Stewart, who lives in Bristol, Virginia.
A couple of days ago, my brother and I had
to leave our eighty nine year old mother alone in
the I see you of the local hospital because it
had to ban visitation due to the coronavirus. Of course,
(43:22):
we totally agree with the precautions, and even she understood
that they were necessary. But it's so difficult, especially when
right before I left, she clasped my hand and said,
I don't want you to leave me. However, her nurses
have been absolute angels. They have adopted her and even
(43:48):
fixed the face time on her phone so that my
brother and I can chat with her. So every afternoon
one of the nurses holds up the phone own and
calls us and we're able to have a nice long
talk with our mom and just really see how she's doing,
(44:10):
and she can see us. That gives her a lot
of comfort. Um, we can't even describe how grateful we
are for these medical professionals who are not only using
their medical knowledge on the front lines of this crisis,
but who also are providing a conduit of compassion that
(44:37):
enables families like ours to stay together, even though it
times that's only in a virtual way. Thanks for your
hard work and inspiration during this crisis, and thanks so
much to the our ends and other medical staff who
(44:59):
are both warriors and angels during this time. Thank you, Lee.
We wish you and your family well, and of course
the same to all of our listeners. You can keep
sending your moments of kindness. I think we could all
use a dose of the fields. Just leave your name
and a detailed message at eight four four four seven
(45:22):
nine seven eight eight three again eight four four four
seven nine seven eight eight three. You can also email
me at info at Katie Kirk dot com. Just put
kindness in the headline. For the most up to date
information and guidance on the coronavirus pandemic, please visit the
(45:42):
CDC and the World Health Organization. You can also check
out our morning newsletter, wake Up Call. You can subscribe
to that and get everything you need to know every
morning in your inbox. Just go to Katie Kurk dot com.
We'll be continuing this special coronavirus coverage on Next Question
Him for the weeks to come. You can subscribe to
(46:02):
us on Apple podcast, the I Heart Radio app, or
wherever you listen to your favorite shows. Until next time
and my Next Question, I'm Katie Couric. Thank you so
much for listening, and stay safe everyone. Next Question with
(46:28):
Katie Couric is a production of I Heart Radio and
Katie Currik Media. The executive producers are Katie Kurik, Courtney Litz,
and Tyler Klang. The supervising producer is Lauren Hansen. Our
show producer is Bethan Macaluso. The associate producers are Emily
Pinto and Derek Clemens. Editing by Derrek Clements, Dylan Fagan
and Lowell Berlante, Mixing by Dylan Fagan. Our researcher is
(46:53):
Gabriel Loser. For more information on today's episode, go to
Katie Currek dot com and follow us on Twitter and
in Stagram at Katie curric For more podcasts for my
heart Radio, visit the I heart Radio app, Apple podcast,
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Host
Katie Couric
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