New York Times Science Reporter Apoorva Mandavilli On The Challenges of Covering COVID 19

Apoorva Mandavilli

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Female : 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 care of the future. This week Mark and
Margaret speak with Apoorva Mandavilli, i nvestigative journalist in
science and medicine writer for The New York Times . She ’s been
writing compelling series of pieces on the COVID - 19 pandemic. With
more in - depth analysis of how t he coronavirus spreads even from
asymptomatic people , h ow school s should be prepared for the new
school year, and how this pandemic is yielding an impressive new
body of science f or preparation for future pand emic .

Lori Robertson also checks in , the Managi ng Editor of FactCheck.org
look s at misstatements spoken about health policy in the public
domain , separating the fake from the facts . W e end with a bright idea
that’s improving health and well - being in everyday lives. If you have
comments please e - mail us at [email protected] or find us on
Facebook , Twitter , or wherever you listen to p odcast . Y ou can also
hear us by asking Alexa to play the program Conversations on Health
Care . Now stay tuned for our interview with The New York Times
science writer Apoorva Mandavilli here on Conversations on Health
Care.

Mark Masselli : We're speaking today with Apoorva Mandavilli , a ward winning
investigative journalist and science and global health writer for The
New York Times , curr ently focused in on the coverage of COVID - 19
pandemic. She has written for numerous other publications including
the Atlantic, The New Yorker Slate and Scientific American, and is the
2019 recipient of the V ictor L. Cohn prize for excellence in medical
rep orting.

Margaret Flinter: Ms. Mandavilli is the Founding Editor in Chief of Spectrum an online
news site focused on autism that reaches millio ns of followers. She
was the co - founder of Culture Dish, a nonprofit dedicated to
advancing diversity in science j ournalism, and she was an adjunct
professor at NYU Science Health and Environmental Reporting
Program and recently was the science writer in residence at the
University of Wisconsin . Apoorva welcome to Conversations on
Health Care.

Apoorva Mandavilli: Than k you for having me.

Mark Masselli : Apoorva, you've been writing a compelling series of pieces for the
New York Times to help us better understand the rapidly evolving
science around the COVID - 19 pandemic, what it is and how it spreads ,
what the scientific community is gaining consensus on and what
public needs to know to better navigate their way through this crisis .

Apoorva Mandavilli

Really, as someone who's an award winning science reporter
accustomed to cover medical mysteries, I wonder if you could help
our listeners un derstand the complexity of this challenge of
communicating credible, empirically driven information on COVID - 19.
What's been the biggest challenge you faced in doing this?

Apoorva Mandavilli: You just mentioned that this pandemic has been rapidly evolving and
the knowledge has been evolving , and I think as a reporter that has
been the biggest challenge. I think to the people outside of the
situation, it might seem like we haven't gotten the answers fast
enough. But in reality in some ways, this is the faste st I've ever seen
science move . We didn't know anything about this virus six, seven
months ago , a nd now we know a lot more. We know a lot more about
how it spreads. We know a lot more about how people's bodies react .
W e know a lot more about what does and doesn't help with
treatment. All of those things have come at breakneck speed. I t's
been really overwhelming as a journalist to be looking at the volume
of papers coming through. A lot of them aren't peer reviewed yet ,
t hey're just pre - prints , so w e're hav ing to do our own sort of peer
review and sending them to experts we trust and having to figure out ,
which ones are worth covering , w hich ones are good , w hich ones are
not . I think just the volume and the pace have both been challenging.

Margaret Flinter: Well Apoorva , to that point. One area that you know growing
consensus , though , we are waiting for more papers that are peer
reviewed. Is t hat the virus is being spread through airborne
transmission , and there's really hundreds of experts that they're citin g
now from countries all over the world. But the World Health
Organization still seems to be lagging a bit on confirming that
consensus. Schools a n d places like Georgia and Texas are opening
without mandatory mask r ules , though most public health experts
a gree that's the best protection against airborne transmission. Now ,
New York state Governor Cuomo has determined New York schools
could open the superintendent's can make up their own minds about
protocols . Different approaches across the state and the cou ntry , but
here we are in mid - August , and based on your research as we send
kids and teachers back into schools, what protocols should absolutely
be put in place to prevent flare ups like we've already seen in some of
the early opening scho ol districts arou nd the country?

Apoorva Mandavilli: This is a very complicated issue, as you know . I think th e aerosol part
of it has been extremely complicated. As you mentioned, the World
Health Organization has been somewhat reluctant to really
acknowledge that this mi ght be contributing to the pandemic. I think
their objection has been that nobody has been able to capture
infectious virus from the air , that people have been able to see viral
genetic material but not live virus. Well, in fact, there are two new
papers, bullets, sort of suggesting that it is possible to see infectious

Apoorva Mandavilli

virus. I think some scientists have called this sort of smoking gun
evidence, and I think that does tell us that it's very important to pay
attention to indoor environments like schools.

I t hink Governor Cuomo made the right call in many ways for New
York City because we do have one of the lowest rates of transmission
in the country. We have done very well since the spring a t keeping
our case counts low. However, a lot of the schools in the c ity are not
really ready to provide the kind of safe environment that would limit
transmission of the virus . For example, a lot of the school buildings
are over a 100 years old, they have really outdated ventilation
systems . For a lot of them ventilation j ust means opening the
windows and having a roof duct. T hose things are not going to
necessarily keep the air flowing well enough to make sure that the
virus doesn't linger in the air.

On average, they say school buildings should have three to four full air
exchanges, meaning all of the air in the room needs to be replaced by
fresh air. M ost schools are averaging maybe one for an hour . They're
really far below where they need to be. Also, schools will need to
make sure that kids wear masks as much as possibl e. Certainly
teachers and staff will need to wear masks. They'll need to have plans
to make sure that kids are separated enough from each other
physically that anybody who is sick -- there's a protocol for how they
would treat a sick kid or a sick staff me mber. What would they do?
Would they shut the schools down for one case? There are just so
many questions that superintendents and principals and teachers and
parents need the answers to before we open the schools.

Mark Masselli : Well, that's very helpful. I wonder if we could look just beyond the
schools to the broader population. You recently wrote a piece
concerning a study out of South Korea that examined asymptomatic
transmission, while roughly 30% of the coronavirus cases are
asymptomatic , the South K orea study show ed these people still carry
a very high virus loads in their lungs and in mucous membranes,
which can mean they can transmit the disease even if they feel fine.
I'm wondering if you could talk to our listeners more about this
worrisome revel ation, and how it could lead to more so called super
spreaders events, as many Americans are participating in these large
public gatherings . I saw that there were , whatever, hundreds of
thousands of people on their bikes recently , but talk to us about the
implications here.

Apoorva Mandavilli: I think asymptomatic transmission of the virus is something that really
came as a surprise to scientist. It's not that it doesn't happen for other
viruses, but they didn't really expect it to be playing a major role t o
have as many people be infected and not be symptomatic, as we
found now that people with coronavirus are that it's up to 30% . S o me

Apoorva Mandavilli

studies have said even more , said 40% , 50%. The South Korean study
you mentioned that I recently wrote about that did come at about
30%. T hat study was done pretty well. They tracked these people over
time . T hey looked at people who had no symptoms at the beginning .
So me of them did develop symptoms later on, which is this slice of
population we call pre - symptomatic . B ut then some people never
develop symptoms at all , a nd they still had a lot of virus in their
systems.

You said when you were describing this that they can easily transmit
the virus , and I think that's a piece that we're not actually fully sure
off yet. It's clear that they probably can. It's likely that they probably
transmit less easily and less efficiently than somebody who was , for
example, coughing or sneezing. People who are coughing or sneezing
and feeling really sick are probably more likely to stay home, t h a n go
into a crowded situation and spread it to other people . The worry is
not so much how much they are spreading, but that enough of these
people are out there that it does probably contribute to keeping the
virus going.

Y ou m entioned super spreader eve nts, and there's more and more
thinking that those events in particular happen with aerosol
transmission. An asymptomatic person may not cough or sneeze, they
would still be breathing out aerosols, so they might still be triggering
these super spreading ev ents . It's very important that even if people
aren't feeling sick, that they do get tested if they've been exposed to
anyone, and they stay home and wear a mask and practice physical
distancing.

Margaret Flinter: Apoorva one piece you recently wrote really put the COVID - 19
pandemic in a big global context even beyond COVID , if there's
anything else we can think about these days and the title , The B iggest
M onster is S preading and it's not the Coronavirus, I think really
captured people's attention. You noted that Coronavirus is l eading to
a spread of some long - standing health scourges that we have not yet
eradicated but had actually been making quite good progress on
particularly Tuberculosis, Malaria and HIV infection which had been
coming under better contr ol in recent years. Help us to understand
the gravity of this situation , a nd why are we seeing such a spike in
these long - standing scourges in the wake of the pandemic?

Apoorva Mandavilli: Long - standing sco urges i s exactly right. I mean, these things have
been around forever . T B is and old disease, and people are used to
take it a lot more seriously back in the day because it did kill a lot of
people. It does still kill a lot of people. T he TB and HIV and malaria
were coming under better control , a nd that's absolutely true . B ut still
in 2017 TB killed almost 1.5 million people. T here are particular parts
of the world that have really struggled with it. O ne of the things I

Apoorva Mandavilli

discovered in reporting that piece is that all of these public health
experts are just so desperate for attention to this issue because they
are watching decades of their work being essentially washed away by
the coronavirus pandemic , b ecause of the lockdowns people are not
able to get to clinics that they need to get to , to in order to be
d iagnosed with TB or diagnosed with malaria and HIV, or people with
HIV and TB are not getting access to the drugs that they need in time.

Lockdowns in various parts of the world have also made it really
difficult for supplies to get to the countries. A lot of countries simply
didn't have the time to stockpile all these TB and HIV drugs for their
citizens , a nd so they're running out. Meanwhile, the companies that
make these diagnostic test , that make these drugs are either shut
down or they have completely p ivoted to making diagnostic tests and
medicines for COVID because , as you can imagine, there's a much
bigger demand for that now from richer countries who are willing to
pay much higher prices , and so t hey are completely switching to the
coronavirus . In th e meantime, just hundreds of thousands of people
who need to be diagnosed with these other diseases are not getting
the help that they need.

Once you don't get diagnosed, you don't get treatment. If you don't
get treated in time, you might develop drug res istance, you may die.
T hese are just chains of events that are being set into place right now.
U nless countries really take very big steps to stop this from
happening, I think we're looking at a resurgence of all three of those
diseases .

Mark Masselli : We ’ re speaking today with Apoorva Mandavilli an award winning
investigative journalist in science and global health writer f or The New
York Times. She is also the Founding Editor in Chief of Spectrum an
online publication covering autism . Apoorva you've craft ed really a
unique journalistic specialty covering emerging science behind
medical mysteries and certainly COVID - 19 is certainly an opportunity
to flex that muscle . Y ou spen t considerable time though also covering
autism, a condition still rife with many u nknowns in this information ,
a nd perhaps really the biggest belief is that vaccines cause autism.
W hile the science is clear , i t's re ally spawned a significant anti - va x
movement throughout the country , really throughout the globe. Now
we're watching the de velopment of a number of vaccines for COVID -
19, really with a widespread global deployment expected sometime
next year . I’m wonder ing if you could just share your insights that
you've gained about vaccine safety, and perhaps really the challenge
that the s cience community faces in getting widespread adoption of
whatever vaccine proves to be the most efficient .

Apoorva Mandavilli: I'll say up front here that I have not been writing as much about
vaccines for the coronavirus , that my colleagues Carl Zimmer an d

Apoorva Mandavilli

Denise Grady and Jen Hoffman, at the New York Times have all been
writing about it much more and especially about vaccine hesitancy.
But I will say that based on my 13 years at Spectrum , an autism
magazine . One thing I learned is that there is no convinc ing , the really
hardcore anti - vax contingent . You may get to some small number of
them, but the vast majority have made up their minds and they are
not going to listen .

I think the strategy , really , public health strategy needs to be focused
on the people who are undecided, who aren't sure how safe this
vaccine is. We're not sure how effective it is. We're not sure how
safely it's being tested and whether it's being rushed through in
dangerous ways. I think that's where a public information campaign
would b e the most effective and helpful is to sort of counter the anti -
vax misinformation campaign with equally widespread clear scientific
straightforward information about what the vaccine can do , and a lso
to be transparent about what it cannot do. I think suga rcoating things
is not actually going to help because people look right through it, or at
the very first time that they hear anything negative, they'll feel lied to.
It’s ver y important to be honest.

For example, there are early reports that some of the va ccines are
causing some side effects. Nothing really crazy, just a throbbing arm
and some pain, similar to what we see with some other strong
vaccines. But I think being very transparent about that upfront and
weighing the cost and benefits and saying, yes you may feel these
things, but on the other hand you will be protected to this degree.
That kind of straight talk can go a really long way to making sure that
people really trust what they're hearing.

I also want to say , I mean, it's -- I think it's not u nusual that for a new
vaccine for people to be a little wary . I saw the other day that there
was a poll about the polio vaccine when it first came out in 195 4 . V ery
similar numbers of people about 30% or 40% said they wouldn't get it ,
a nd they did eventual ly, because they realized how important it was . I
would like to stay optimistic and think that the vast majority of people
will see the benefits. We also can't discount the possibility that the
vaccine will be mandated by businesses and schools and local
g overnments , so I think there's some hope.

Margaret Flinter: Well Apoorva we find your reporting so compelling . A big piece of that
is the way you incorporate the human element into stories that are
also packed full with vital empirical information from fro ntline
clinicians in the ICU s to health workers in Sub - Saharan Africa
researcher in an infectious disease lab. These voices really bring the
stories home . Y ou're in a rare position, I think , to illuminate the reality
of this pandemic to a population that m aybe still hasn't fully
comprehended the gravity of the situation. Hard to believe , but you

Apoorva Mandavilli

know there are people who haven't had any first, second or third
degree contact yet with anybody affected , a nd so that's still an issue
out there. I wonder if you w ould take a minute or two to just share
some of the more compelling dispatches from those frontline people
that you've spoken with , that have really brought this crisis home to
you .

Apoorva Mandavilli: I think one of the most recent example I can think of is Uche
Blackstock , who's a black doctor in Brooklyn that I talked to for a
recent school story I did. I think that she really is a good illustration of
what you were talking about just now about how complicated these
things can be, b ecause she is an emerg ency room urgent care doctor,
so she has cared for hundreds of COVID patients and seen people die.
She's also a mother of two young kids and has to figure out what to
do about the school situation. She's also done a lot of work on public
health equity and racial inequities in health care . She wears many
hats , and I think the re -- i n some ways, we all are doing that with this
pandemic .

We are all parents and sisters and brothers and professionals who
have to figure out how to go back to school. An armchair
e pidemiologist trying to figure out the best information to protect
ourselves and our families , and so t hat's one of the reasons that I've
really found it helpful to talk about the real people doing the work
because it's easy to get lost in the numbers . I t' s easy to just hear
160,000 deaths and not really think about how each of those is a
person with all of these societal connections and impacts and roles in
life . I try to do that , it's not always easy. As you noted in the global
health piece, for example, I mean some of those stories are
heartbreaking , so i t's not easy to wade into those stories.

But I think it's much more compelling for Dr. Giorgio Franyuti from
Mexico, whom I quoted in my global health story who is living the
front lines, in a makeshift h ospital treating people . I t's much more
powerful for him to say what the difference between T B and
coronavirus is , and th at T B is the biggest monster of all and much less
effective for me to just say that , not really living the day - to - day
scenario.

Mark Ma sselli : Apoorva , I was thinking that you were talking earlier about
Tuberculosis, Malaria and HIV and how labs have sort of shifted away
from focus in on that -- all the scientific laboratories it seems to be in
the globe are focused in on COVID - 19 which c ontinues to be really
captivating the scientific global communities, time and attention . I’m
wondering just it has -- it may be too early to think through this, but
what new scientific discoveries do you think might emerge out of all
the focus in on this v irus, anything that you're seeing or is there any
conversation going on of collateral benefits that might arise in the

Apoorva Mandavilli

attempt to find a breakthrough around this vaccine?

Apoorva Mandavilli: I think absolutely, I think there's so much concerted attention b eing
paid to this coronavirus right now, and so many brilliant people
working on it that we will uncover some insights that will translate to
other diseases. For example, the airborne transmission that we were
talking about , t hat's not just true for corona virus . That's also true for
influenza. T here are experiments that were never really done with
influenza, but now because of the urgency to do them for the
coronavirus w e a re learning a lot more about the flu virus and how
that is transmitted by air. Simila rly, there will be insights we'll gain
from vaccine studies. We're learning a lot more about the seasonal
coronaviruses because we're studying this new one , s omething that
people have never really paid much attention to , it was never see n
like a priority. Y e t they cause most of the common colds, about 30%
of common colds a nd so it is important for us to know how they
operate.

The re also just infectious disease insights into immunology. I think the
general public is learning a lot more about how our human bo dy
works , h ow they respond to infectious disease works . I mean, I did not
really think that I would be able to use the word plasma blast in a New
York Times story , a nd yet that's what I'm able to do, because people
want to understand . People want to unders tand what antibodies are ,
w hat the virus really means , w hat all of these things mean . I think it's
a great opportunity for us as a society and for scientist to really learn
some new insights and to make sure that we all sort of share in that
common knowled ge, because we're going to need it . There will be
another pandemic and we will need it .

Mark Masselli : Apoorva , just a conversation about monoclonal antibodies. What are
we seeing ? What are you hearing about the work that's being done
there? I think we've had a couple of people on who sa y keep your eye
on this , b ecause if the vaccines really don't work, this might be the
on ly life jacket out there for us .

Apoorva Mandavilli: Yeah, I agree with that. I'm actually working on a story right now
about a team tha t's developing them. T here's multiple ones in trials
already. There's one from Regeneron and one from Eli Lilly. There are
some that are cocktails and one some that are just single, I think the
cocktails are probably the best bet. I think that's probably w here we'll
get the most benefit. But yeah, absolutely , t hose will be ready sooner
than the vaccine. T hey'll probably be a better option for, for example,
older people who can't get vaccinated or for kids who may not be able
to get vaccinated , o r people wit h certain conditions. There are a lot of
people who m we ’ re not necessarily testing it in the vaccine trials, so
we won't know about safety, and they might be able to safely get the
monoclonal antibodies.

Apoorva Mandavilli

Mark Masselli : It doesn't sound like there's been a lot of conversation around that
broadly , s o we look forward to your reporting on that.

Apoorva Mandavilli: Yeah. I'm hoping to change that.

Margaret Flinter: We've been speaking today with Apoorva Mandavilli , an award
winning investigative journalist and s cience and global health writer
covering COVID - 19 for the New York Times . You can find her
impressive body of work on the pandemic by going to
www.nytimes.com by Apoorva Mandavilli or follow her on Twitter
@ A poorva_n yc. A poorva we want to thank you for your commitment
to producing great science journalism, especially at this time when
the world most needs it , a nd for taking the time to join us on
Conversations on Health Care today.

Apoorva Mandavilli: Thank you very m uch. It was my pleasure.

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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 health care 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 US politics. Lori,
what have you got for us this week?

Lori Robertson: In recent press briefings, President Donald Trump has made false and
misleading statements about COVID - 19 the disease caused by the
new c oronavirus . In late July, Trump falsely said that large portions of
the country are “ c orona free ” . We found that only 35 of the nation's
3144 counties or county equivalent had not reporte d a single
c oronavirus case in the previous week. That accounts for less than
0.02% of the total US population. The majority of these counties are
located in the sparsely populated w est, including multiple in Alaska,
Montana, Nebraska, Idaho and Texas.

The President also claimed without evidence that Portland and Seattle
were seeing a rise in COVID - 19 cases because of protests. Both cities
have observed a recent rise in cases but the health department for
both areas told us the available data do not show th e protests are
responsible for an uptick in cases. For example, Dr. Jeffrey Duchin , the
Health Officer for Public Health for Seattle and King C ounty told us
that of the approximately 5000 people who said they attended a
protest event and were tested at a c ity sponsored testing site only
0.2% were positive for COVID - 19. He said that case investigations
were finding that a majority of the recent cases could be tied to a
general increase in activity in the community, including social
gatherings and exposures w ithin households and at workplaces.

Trump has noted that other nations are currently experiencing

Apoorva Mandavilli

worrisome upticks in cases. While this is true , h is emphasis and
description of these surges could leave audiences incorrectly believing
the US is in better s hape than certain parts of Europe and Asia . In a
th
July 30 briefing, he pointed to a resurgence in cases in Japan, China,
Australia, Belgium, Spain, France, Germany, Israel and Hong Kong. But
all of those places had successfully reduced their case numbers to low
levels in May and June, which the US did not manage to do and all of
them , other than Israel are far below the US’ seven day average per
capita case count. That's my fact check for this week. I'm Lori
Robertson, Managing Editor of FactCheck.org.

Mar garet Flinter: F act C heck.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.chcradio.com . We'll have
FactCheck.org’s Lori Robertson check it out for you here on
Conversations on Health Care.

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Margaret Flinter: Each week Conversation highlights a bright idea about how to make
wellness a part of our communities and everyday lives . People living
in Sub - Saharan Africa have tougher odds at overcoming diseases. T he
problem is not just the lack of access to health care providers, but
once someone is diagnosed with an illness, access to vital life saving
medicine is out of reach for many who are sick , s imply because they
can't afford the m.

Gregory Ro ckson: Africa has some of the highest drug prices in the world, simply
because it's a free pric ing market . Y ou can take a single medicine and
two pharmacies next to each other will sell that same drug at wildly
different prices.

Margaret Flinter: Gregory Ro ckson is the founder of mPharma , a nonprofit organization
that’s seeking to address inequities in drug prices in Africa, and the
supply chain tha t often puts these life saving drugs out of reach of the
people who need them. m P harma operates in four African countries,
it decided to tackle the problem by redirecting the supply chain that
forces small independent pharmacies and clinics to source their own
drugs and health, offers these entities the chance to outsource their
procurement for pharmaceuticals.

Gregory Ro ckson: We realized that if we could begin to bring together all these
independent pharmacies and remove the pressure that they have to
fac e in sourcing their own drugs , w e can begin to address the issue of
medicine availability and affordability.

Margaret Flinter: Ro ckson says they help improve the drug procurement supply chain
by collecting data on actual drug sales, which allows health car e

Apoorva Mandavilli

entities to avoid over or under stocking. I t reduces their vulnerability
to fraud and corruption which sadly is rampant in drug supply chains
in parts of the world.

Gregory Ro ckson: The beautiful thing about the service that we offer them is that not
onl y are we taking ownership of the supply chain, we're also providing
the financing to purchase the inventory. We offer them a simple value
proposition , pay only when you dispense the drug to the patient.
Beyond having the p rice available , we actively help t hem manage
their inventory.

Margaret Flinter: Ro ckson says another important benefit more affordable drug
supplies, health c linicians better manage patient outcomes. m P harma
was a 2019 recipient of the School of Foundation's Entrepreneurship
Award .

Gregory Ro ckson: With ou r focus on bringing down the cost of drugs that there wi ll be a
systemic change like even other actors will be forced to reduce their
prices .

Margaret Flinter: m P harma , a nonprofit entity that utilizes reliable data on drug usage ,
eliminat es fraud and waste in the drug supply chains, makes life
saving medications more readily available to some of the world's most
vulnerable people, improves outcomes and saves money. Now that's
a bright idea.

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

Margaret Flinter: And I'm Margaret Flinter.

Mark Masselli: Peace and Health.

Female : Conversations on Health Care is recorded at WESU at Wesleyan
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