America’s Loneliness Epidemic Amid COVID-19: Former Surgeon General Vivek Murthy on the Toll of Isolation on America’s Health

Dr. Vivek Murthy

[ Music ]

Margaret Flinter: Welcome to Conversations on Health Care with Mark Masselli and
Margaret Flinter a show where we speak to the top thought leaders in
health innovation , health policy , care delivery and the great minds
who are shaping the health ca re of the future. This week Mark and
Margaret speak with former U.S. Surgeon General Dr. Vivek Murthy,
where he championed the cause of treating addiction and the opioid
crisis as a chronic disease. He's written a new book on the epidemic of
loneliness tog ether the healing power of human connection and
sometimes a lonely world in which he addresses the widespread
epidemic of loneliness and its impact on public health and how the
pandemic is amplifying the need to address this important issue.

Lori Robertso n also checks in , the Managing Editor of FactCheck.org
look s at misstatements spoken about health policy in the public
domain , separating the fake from the facts, and we end with a bright
idea that’s improving health and well - being in everyday lives. If yo u
have comments please e - mail us at [email protected] or find us on
Facebook , Twitter , or wherever you listen to Podcast and you can also
hear us by asking Alexa to play the program Conversations on Health Care . Now stay tuned for our interview with Dr. Vivek Murthy here on
Conversations on Health Care.

Mark Masselli : We're speaking today with Dr. Vivek Murthy, 19th U.S. Surgeon
General appointed by President Obama. He's former Vice Admiral of the Public Health Servi ce Commissioned Corps and is the founder of Doctors for America, a coalition of 18,000 clinicians dedicated to building a high quality affordable health care system for all . He's a
distinguished scholar at the Johns Hopkins Bloomberg School of Health.

Marga ret Flinter: Dr. Murthy launched several important initiatives whil st serving as the
Surgeon General issuing the first Surgeon General's report on addiction that defined it as a chronic illness. He also launched major
initiatives to target the opioid crisi s and the vaping crisis. He
designated the epidemic of isolation and loneliness as a major public
health threat. He's published a new book on that topic Together : The
Healing Power of Human Connect ion in a Sometimes Lonely World .
Dr. Murthy, welcome to Con versations on Health Care.

Dr. Vivek Murthy: Thank you so much. It's good to be with you.

Mark Masselli : First of all, congratulations on the new book “ Together ”, and really it's
a topic that's gained wider attention in recent years, this widespread
epidem ic of loneliness that really poses an enormous public health
challenge for large sectors of our population, but it's certainly being
amplified by orders of magnitude during the coronavirus pandemic.
Then you became aware of this really silent crisis pretty early in your

Dr. Vivek Murthy

tenure as Surgeon General, I'm wondering if you could help our
listeners understand the scope of the epidemic of isolation and the
real measurable impact it's having on population health?

Dr. Vivek Murthy: Absolutely. Well, first of all, tha nk you for recognizing just how
important and common the feeling of loneliness is, and you'll hear the
term loneliness and isolation, both used . I want to make a distinction
between the two. Loneliness is a subjective feeling of not having
sufficient socia l connection in your life. It's distinct from the objective
term of isolation, which is more a descriptor of the number of people
you have around you , but what really matters is how you feel about
those connections. Wh at I realized when I was the Surgeon G eneral ,
when I had the chance speaking to people in many communities
across the country . Is that I realized that loneliness was a lot more
common than I thought. I thought I would go to visit people and hear
stories of concerns about depression and anxiety and about substance
use disorders , in the opioid crisis. What I didn't expect to hear were
these threads of loneliness that w ove their way through those
narratives . People would never say I'm lonely , t hey would say I feel I
have to carry this entire burde n all on my own, or I feel if I disappear
tomorrow, no one would even notice. That was one of my first clues
hearing this again and again, f rom moms and dads in the Midwest, to
people in the small fishing villages in Alaska . To hearing from it
members of C ongress in Washington D . C. It made me realize , one ,
that the loneliness that I had felt as a child, but also the loneliness
that I had seen so often in patients as I cared for them, when I was
practicing up in Boston that these were not unique to my experi ence,
but th at they were far , far more common than I thought. According to
the 2018 Kaiser economists study, about 22% of adults in America are
struggling with loneliness. That's more than the number of adults who
have diabetes. It's more than the number o f adults who smoke . In the
UK about 25% of adults admit to struggling with loneliness and many
other countries around the world say that they are lonely, but it's also
incredibly consequential for us.

When you look at the data of people who struggle with l oneliness
have an association with an increased risk of heart disease, dementia,
depression, anxiety, sleep disturbances, as well as pr emature death .
So it was that recognition that loneliness is both common and
consequential that ultimately led me to focu s on it.

Margaret Flinter: Well, Dr. Murthy - Mark and I have recently welcome d Nicholas
Kristo f f and Sheryl WuDunn to the program. They were talking about
what we have come to refer to as the de a ths of despair that lead to
shorter lives in America. I know public health concerns really occupied
much of your attention and efforts a surgeon general with addiction,
chronic health issues and the like , but you say that all of these really
have loneliness as one of their underpinnings and so give us some

Dr. Vivek Murthy

more ins ights into how lonel iness became so pervasive and your
thoughts on how that's impacting really all sectors of society o u r
sch ools, workplaces , o u r communities?

Dr. Vivek Murthy: Not only is loneliness common and does it have a serious impact on
our health, helping to drive in a sense many of the common
conditions like depression and addiction and anxiety . On the opposite
side of the house , social connection is a powerful resource that we
have that can not only enhance our health , that can enable us to
perfo rm better in the workplace and in school, which in turn has an
impact on the division and political polarization that we're
experiencing today. Part of the reason is that as human beings, we
were designed to connect with each other , to live in trusted netw orks.
When we were separated from those networks, it actually placed our
body in a physiologic stress state. In the short term, we were pushed
to seek out connection in the same way that hunger or thirst push ed
us to seek out food or water. When that stres s state lasts for a long
period of time, it can increase levels of inflammation in the body and
lead to damage to tissues and blood vessels and ultimately increase
our risk for chronic disease . A big part of that solution has to be
bringing ourselves back to social connection and recognizing the role
that social connection has played for a millennia in our lives in
keeping us healthy and keeping communities healthy. I think if you're
a manager who runs an organization and you're trying to think how
do I ens ure that my workforce is healthy? How do I ensure that they
can do the best job possible? It turns out there's growing data that
loneliness in the workplace is an important de tractor from
productivity and engagement. And similarly with kids, it was
heartbr eaking for me to see how many young people despite how
connected they are, by technology, said that they really struggle with
this sense of loneliness. We want to set them up for a healthy and
fulfilling life. We have to think about how to build strong soc ial
connections in their life.

Margaret Flinter: Now let me try to weave together a couple of thoughts on social
connection and general isolation and thinking about social connection
and about the work that Robert Putnam has done in terms of Bowling
Alone. It seems like we're bowling as much but we're not bowling in
teams. Then I'm reminded of the powerful song “ Hello in There ” from
the late John Pri ne , a song he wrote decades ago about the plight of
elderly living in general isolation in their later years, and the song
suggests that we seek out someone who may be alone and just say
hello. You'll note that there is a growing movement to link those who
are alone, especially the elderly. However, it's become more difficult,
obviously with a pandemic and famili es are no longer able to visit
their loved ones in assisted living facilities or even at home for fear of
spreading the virus. Maybe you could share with us some of the
creative ways people are connecting with those who might be

Dr. Vivek Murthy

isolated and what kinds of interventions have you seen that are
showing promise?

Dr. Vivek Murthy: Well, this is an unusual time that we are living in , but I think what's
also been really exciting and heartening for me to see . Is just how
people are responding with extraordinary kin dness, compassion and
creativity. Now, I have found that , that neighbors are dropping care
packages off to other neighbors who are elderly or neighbors who are
healthcare workers and who are putting themselves on the line j ust as
a show of support. I found employers who are having to turn
everything upside down to shift to telework, but recognizing the
impact that's going to have are actually started choosing to focus first
and how their employees are doing and are asking them how they can
best support them in their struggles to home - school their children .
They're stepping up to make sure that people have food on the table,
recognizing these are difficult times , that has been really encouraging
to see. Even individuals , I've seen them find creative ways to c onnect
in this time, everything from having virtual dance parties, to having
virtual work rooms where everyone can have their computer or iPad
on and can just work silently on their own , but I do think that there is
an extraordinary opportunity that we hav e here in the midst of all of
this pain and chaos. That's an opportunity to step back and to
reassess our lives and ask this question - Where do people fit into our
lives? What priority do we want to give to relationships , once this
pandemic is over? In my own life, my stated priorities are very clearly
my parents, m y sister , my wife, my children, it's people , b ut my live d
priorities have not always been consistent with that . Where I put my
time, my focus has often been predominantly on work. I've also
allo wed myself to be distracted of ten and when I'm with the people
that I love drawn into my inbox or onto my social media feed or into
something else. This though, I think, is an opportunity for us to reset
that . To make sure we're dedicating at least some ti me each day to
the people we love. Make sure that that time actually counts by
eliminating distraction. It's a time also for us to recognize that one of
the most powerful antidotes to loneliness is service. When we reach
out to each other, whether that's c hecking on a neighbor or dropping
food off to a co - worker colleague who's struggling to home school
and telework at the same time . Those small acts of service help
strengthen our connection with others just as they reaffirm for us that
we have value to giv e to the world. If we do these things together, my
hope and I believe is that we can emerge from this pandemic more
deeply connected than before this all began.

Mark Masselli : Well, Dr. Murthy, thank you . Before the pandemic, the number one
crisis that we were concerned about , that face d our country and that
we were very engaged in was the opioid crisis and death by opioid
overdose , was overwhelming families and communities. Your seminal
Surgeon General's report on addiction really sought to put the notion

Dr. Vivek Murthy

to rest, that this was a moral failing by society. I think there's been
some great progress to address addiction as a chronic disease and we
would like to give you a chance to reflect on the progress that's been
made in treating and addressing addiction as a chronic health issue.

Dr. Vivek Murthy: Well, I do think that this has been one of the brighter spots for our
country, the progress that we're making in addressing addiction, but I
do feel heartened that we've made progress in a few areas. One is I
do t hink we are slowly rolling back this stigma around addiction,
helping people understand that addiction is not a character flaw or a
sign that you are fundamentally broken , but this is an illness tha t
many of us could be susceptible to . The second area wher e I think
we're making headway is on extending treatment to people who need
it. Medication assisted treatment does work with medications like
Buprenorphine , but despite that, we have struggled to get rid of
misinformation and stigma around M A T and to adequ ately fund M A T.
We have seen now bills coming through Congress that have been
passed and signed by President Obama and later President Trump
that have put money toward the epidemic. It's not nearly enough,
unfortunately , but it is a move in the right direc tion. I think the other
thing is a growing recognition within healthcare systems, that if we
really want to get treatment right, that we've got to integrate it with
primary care . We can't have treatment be, a building off in a
forgotten corner of your comm unity that you try to visit. It's got to be
part of the healthcare infrastructure. It can't be a stepchild anymore ,
but with all of this , is this theme actually around how human
connection relates to addiction, without being able to strengthen a
sense of c ommunity for people, that we are not only going to set
ourselves up more for substance use and addiction, but we're going to
have a very hard time addressing it. The founder of Alcoholics
Anonymous was often famous for saying that loneliness was one of
the deeper afflictions that affected those with alcoholism. So many
people that I met on the road who came through that dark tunnel of
addiction and emerged in recovery. Every single one of them said that
there was a person or a group of people who were criti cal to their
success. You don't need an MD or an RN in order to help somebody
struggling with addiction to build a relationship with them . To support
them is just as important a part of the treatment and the cure.

Mark Masselli : We're speaking today with D r. Vivek Murthy. 19th, U.S. Surgeon
General appointed by President Obama. He's a distinguished scholar
at the Johns Hopkins Bloomberg School of Health and author of a just
released book Together : The healing Power of human connections in
a s ometimes lonely world. Dr. Murthy, I think it goes without say ing
the whole world has been up ended by the COVID - 19 epidemic , and
there's a very long road ahead for us to feel somewhat normal . Really
put your hat on , your former role of S urgeon G eneral was really to
rally support around policies that lift all Americans up, maybe shift a

Dr. Vivek Murthy

little to what kinds of coordination and cohesiveness are required
from our governme nt health entities at this time and how might our
health systems look diff erent after all of this passes?

Dr. Vivek Murthy: Well, I do think that one of the is that it has pulled back the curtain on
what is broken in our healthcare system and in our public health
infrastructure . L ong before COVID - 19 was on the scene , w e had been
under investing in departments of health. I heard as I would travel
across the country from State Department's of health that would say,
our budgets were cut during the Great Recession in 2007 - 2008 , and
when the whole economy recovered, our budgets never changed. At
times like this, we depend on those local health departments to do
contact tracing, to help with testing , and so the under investment that
we have made in healthcare and in public health comes at a
tremendous price. I think that this is our opportunity to re - imagine
what the health infrastructure o f this country could look like.

I believe that this is our opportunity to put forward a Marshall Plan for
health that could build the public health infrastructure that we need
filled with all of the core elements that we know are i mportant from
Sentinel surveillance systems , to contact tracing systems, to also the
kind of preventive type measures and programs that we know we
need to help reduce the risk of diabetes and obesity and heart
disease, and to imagine how the federal govern ment needs to
respond in moments like this because there's a lack of funding
available to quickly respond to moments like this. An administration
usually ends up having to go to Congress and spend weeks and weeks
and weeks working out some sort of financia l package. During those
times, we're not investing the resources that we need in the response
strategy. So it's our chance now, though, to think about how we fund
outbreak responses, about how we build really modern age
technology to be able to understand when something is out of the
ordinary , and it also is a time for us to have some hard discussions
about how we use technology to ensure we know what's going on
with public health while also main taining and respecting privacy.

But it's never too early to s tart having that conversation. In fact, I'd
say we're a little too late right now , but we need to start at some
point. We can rebuild our public health system into what it needs to
be so we can serve every person in this country and prevent so many
of the illness es that we know how to prevent.

Margaret Flinter: Dr. Murthy, one group of people I think across the country whose
lives will be sha ped by this memory in some ways are our students
and trainees, our residents and fellows who came into this , and whil e
this was not on their radar . You're a visiting scholar at Johns Hopkins
University. You're the Founder of Doctors for America. My guess is
that you are very connected to the generation that's coming up of

Dr. Vivek Murthy

health professionals across the board. I'm curiou s what your thoughts
are on how the experience of this crisis is going to impact future
training and education for all the health disciplines , not just to meet
the threats such as the one we face now , but because so much
changed in such a short time. Share your thoughts with us about how
this you think will impact the training and experience of this
generation that's coming up now .

Dr. Vivek Murthy: I have had the privilege of speaking with many residents and fellows
and young attend ees over the last few we eks. Let me just first and
foremost say that these men and women are giants , what they're
doing in this moment, the way they're stepping up, it's like nothing
that my generation ever had to do. They are putting their lives on the
line even at times getting sick because they believe in the ideal that
they took a note to support. So that's truly extraordinary. I do think
that this experience will change them, and hopefully for the better.
One of the things is highlighted for us people who are clinicians who
a re on the frontlines are undergoing a tremendous amount of mental
and emotional stress right now , and there will be consequences of
that that will show up in their lives today, tomorrow , in six months , in
a year. We have traditionally not done a good job i n the profession of
paying attention to the mental and emotional needs of our workforce,
all the while recognizing that it's contributing to burnout and injuring
at a deep level that people have committe d their lives to helping
others. So this is a chance for us to ask how do we invest in improving
and sustaining the mental health and wellbeing of healthcare workers
themselves.

The second thing I think , this really elevates for us is the need for
clinicians, for medical professionals to also have an unders tanding of
engagement in public health. For too far too long, these worlds have
remain ed quite distinct. But we know how deeply connected they are.
If the public health system fails, it shows up in the medical system. So
we need to have a much tighter unde rstanding and integration of
professionals who are working across both realms.

Finally, technology , what is so striking about what's happening right
now is that we're being pushed to use technologies that have existed
for years and years and years. We jus t have not found a way to bring
them like into our current practice of medicine. What it i s highlighting
is that medicine has been behind from a technological standpoint.
This is pushing us to accelerate, recognizing that all of the people who
need help th rough telemedicine now that we're still actually going to
have a need for that down the line. There are people in rural areas
who need psychiatric care , who could use telepsychiatry services.
There are people all around the country who don't necessarily ne ed
to come in to the doctor for every visit if they had the ability to just do
a simple telemedicine ca ll, get a consultation at home. I hope that this

Dr. Vivek Murthy

experience will push us to revisit how we take care of clinicians, how
we structure medicine, how we tea r down that divide, that has for too
long existed in betw een medicine and public health.

Mark Masselli: You know, I wanted to tie that back to the sort of heady side of as you
think through this redesign of the healthcare system when you were
in a Wall Str eet Journal event which you envision the f uture of
healthcare, some of it was new technology, but some of it was simply
regulatory relief. You look at the guilds that are controlling all of the
practice of medicine, whether it's insurance companies, or the
practices themselves, we really need to break down some of the
barriers and then have the force multiplier of technology. But tell us a
little more about his new vision for the future of healthcare that you
shared with others.

Dr. Vivek Murthy: I think if we think about healthcare in the future, and what do we
want it to be? What we really want is, first and foremost, a health
infrastructure that helps prevent disease in the first place. That means
that health will have to interface deeply with other secto rs as well,
including the economic sector, transportation and education,
recognizing that these social determinants and drivers of health are
where we need to be as health professionals helping design policy.
The second thing that we need to see in the hea lth system is we need
to see a system that's more and more responsive to people's needs,
including where they need to get their care. If we do our job right and
use technology well, my hope is that we will see care move more and
more from hospitals and cli nics to homes and communities.
Hopefully, if we do that well over time, we will see a need for fewer
hospitals. That is a vis ion I think we can grow toward.

Finally when I think about the people themselves, the nurses, the
doctors, the public health worke rs, the pharmacists, I think that what
we have a real opportunity to do is to make the next wave in
generation of healthcare workers , of clinicians, people who can truly
bring together the mental, emotional and physical dimensions of
medicine. Our educatio n has been so skewed toward the physical
recognizing that, yes, physical health is important, but it's not the only
driver of our health , and it seemed like our mental health was almost
a second concern. When I began seeing patients independently, I still
remember one of the first patients I talked to who was struggling with
loneliness , and it was very clear that this man was lonely because he
said so. He said, You know, I quit my job after I came into some
money, and I moved to a big house in a fancy neigh borhood and I
didn't have my friends or my clients or my colleagues anymore, and I
felt really alone. I felt in that moment so helpless because I had no
idea how to think about loneliness. I had never learned about it in
class. I had never realized that it had health implications.

Dr. Vivek Murthy

But I think that as we go forward, what we need to do is we need to
not only train our clinicians and how to understand how the physical
and emotional dimensions of health go together, but we've got to
train them to be able to co mmunicate that with the public, where a
stigma around mental health is still quite common, that we need
trusted voices to speak up in the public square about how it is that
these different elements of who we are intersect . It's okay to have
struggles with your mental health because guess what so many of us
do . To be able to communicate, provide good care and work to
prevent illness in the first place , this is what a good health system
should do , and it should use technology to enable that . It should lead
wi th the heart while also being informed by the head , and those are
the priorities I think that we have to keep ordered when it comes to
how we approach health.
th
Margaret Flinter: We've been speaking today with Dr. Vivek Murthy, the 19 U.S.
Surgeon General under President Obama. He's a Distinguished Scholar
at the Johns Hopkins Bl oomberg School of Public Health, and he's the
author of the just released book Together: The Healing Power of
Human Connection in a Sometimes Lonely World. Learn more about
his incr edible contributions to public health and American healthcare,
and access his book by going to www.vivekmurthy.com or follow him
on Facebook or Twitter at the Vivek Murthy. Dr. Murthy, we want to
thank you so muc h for your contributions to healthcare, for your
guidance and leadership and your humanity as America's doctor and for the role you're playing in bringing attention to this public health crisis of loneliness. Thank you so much for joining us on Conversatio ns
on Health Care today.

Dr. Vivek Murthy: Thank you all so much, so wonderful to be with you today.

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Mark Masselli: At Conversations on Health Care, we want our audience to be truly in
the know when it comes to the facts about healthcare reform and
policy. Lori Robertson is an award winning journalist and Managing
Editor of FactCheck.org, a nonpartisan, nonprofit consumer advocate
for voters that aim to reduce the level of deception in U.S. Politics.
Lori, what have you got for us this week?

Lori Ro bertson: In announcing that his administration would halt funding for the
World Health Organization, President Donald Trump made a series of
false , misleading and unsubstantiated claims about the WHO.
Regarding travel restrictions and lives saved , the Pres ident said, “ And
if we didn't close our border early, very early, long before the kind of
dates you're talking about, we would have had thousands and
probably hundreds of thousands more deaths. ” We found no support
for Trump's claims. The research on the i mpact of travel restrictions
shows they can delay the exportation of cases, if the restrictions are

Dr. Vivek Murthy

stringent, but they can' t contain the spread of viruses. On travel
restrictions and the WHO reaction , the President said, “ They told us
when we put on our t ravel ban, a very strong travel ban , t here was no
need to do it. They actually thought us .” That's an exaggeration.
There's no evidence WHO leaders have publicly criticized the U.S. for
st
its January 31 decision to restrict travel to and from China .

Trump also criticized the WHO for trusting China's transparency
regarding COVID - 19 , “ The WHO willingly took China's assurances at
face value and defended the actions of the Chinese government even
praising China for its so called transparency. ” But that lacks c ontext.
Trump originally praised China's suppose d transparency as well. It's
true that the WHO Director General complimented China for its
th
response to the outbreak in remarks on January 30 . What Trump
didn't say is that early on, he too, said he trusted what China was
th
telling the U.S. about the virus. On January 24 , Trump tweeted,
“ China has been working very hard to contain the Coronavirus. The
United States greatly appreciates their efforts and transparency. ”

On February 10, he said, “ I think China i s very, you know,
professionally run in the sense that they have everything under
control. ” The President also criticized the WHO for failing to act on
“ credible report ” in December 2019 of person to person transmission .
The WHO wasn't notified of an outbr eak in Wuhan until December
st
31 . The agency always considered the possibility of person to person
transmission . That's my fact check for this week. I'm Lori Robertson,
managing editor of FactCheck.org.

[Music]

Margaret Flinter: FactCheck.org is committed to factual accuracy from the country's
major political players and is a project of the Annenberg Public Policy
Center at the University of Pennsylvania. If you have a fact that you'd
like checked, e - mail us at www.ch cradio.com , we'll have
FactCheck.org's Lori Robertson check it out for you here on
Conversations on Health Care.

[Music]

Mark Masselli: Each week , Conversations highlights a bright idea about how to make
wellness a part of our communities and everyday liv es. In the
emergency room or the ICU , clinicians are confronted with a myriad
of unpredictable medical crisis that sometimes can be challenging to
diagnose. Most of these clinicians are now communicating with
colleagues via their smartphones, often sending images of a patient's
unique symptoms or chest x - rays to one another for shared diagnosis.
ICU Physician Dr. Josh Landy was noticing a growing trend of image
sharing via smartphones to crowd source second opinions from
friends and colleagues across the co untry. But he also was concerned

Dr. Vivek Murthy

about the potential violation of HIPAA regulations. So he developed
an app for that. He created Figure 1 , a sort of Instagram for doctors in
which images can be de - identified but shared across a dedicated
social media platf orm that would allow input from c linicians within
their network.

Doctors are using the app to communicate not only with colleagues
within their hospital settings, but around the world where someone
might have superior expertise with a certain condition. T he app was
recently used to share a chest image of one of the patients who
pres ented with a Middle Eastern virus , MERS. Dr. Landy says the apps
get about a half a million image views a day, with about 80 million
total views so far . He sees the potential fo r this platform only growing
as more young digital natives enter the medical workforce . A free
downloadable app offering secure HIPAA compliant image sharing
among clinicians around the world to reduce the time it takes to zero
in on a diagnosis. Now that is a bright idea.

[Music]

Mark Masselli: You've been listening to Conversations on Health Care. I'm Mark
Masselli.

Margaret Flinter: And I'm Margaret Flinter.

Mark Masselli: Peace and Health.

Margaret Flinter: Conversations on Health Care is recorded at WE SU at Wesleyan
University, streaming live at www.chcradio.com , iTunes, or wherever
you listen to podcasts. If you have comments, please e - mail us at
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