2020: Mark and Margaret reflect on the Year COVID-19 Took Over the World

Mark and Margaret look back at 2020

[Music]
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, global health, and the great minds who are shaping
the hea lthcare of the future.

This week Mark and Margaret will take a look back at what
was one of the most tumultuous years in the modern history
of healthcare 2020 , the year the pandemic swept the worl d
and gripped the nation in its hole . Mark and Margaret look ed
back at their interviews with Dr. Anthony Fauci of the NIH.
They welcomed Harvard Public Health Leader, Ashish Jha, Dr.
Zeke Emanuel as well and Health Tech Innovator Dr. Eric
Topol, who talked about the power of wearables in COVID - 19
surveillance. We a lso welcome Congressman James Clyburn ,
who addressed health inequity against the backdrop of the
Black Lives Matter u prising, and also welcome Michael
Osterholm , now serving on President Elect Biden's COVID - 19
task force .

If you have comments e - mail us at [email protected] or find
us on Facebook, Twitter, or wherever you listen to podcast.
You can also hear us by asking Alexa to play the program ,
Conversations on Health Care. Now stay tuned for a look back
at the tu multuous year that was 2020 here on Conversations
on Health Care .

[Music]

Mark Masselli: Welcome to Conversations on Health Care . I'm Mark Mas s elli .

Margaret Flinter: And I'm Margaret Flinter , here with our year end show.

Mark Masselli: Well, Margaret, it' s the end of the year that can only be
described as an unprecedented year for all of us. 2020 began
with the emergence of this novel virus that grip Wuhan, China
and within weeks it would have a name COVID - 19 , and within
months it would overshadow all othe r news around the world
from that moment until this one . This year, we have watched
the global pandemic stricken tens of millions of people around
the world, leaving more than 1.6 million people dead globally
and more than 300,000 dead right here in the Un ited States.

Margaret Flinter: Well , Mark , in more than 10 years that we've been doing the
show, I can't remember a year in which a single crisis like the
COVID pandemic dominated all news and really all elements of
our lives . W e were very fortunate to wel come some of the
brightest minds in public health and infectious disease to the

Mark and Margaret look back at 2020

show this year , incredible leadership starting with Dr. Anthony
Fauci. Dr. Fauci is the Director of the National Institute for
Allergy and Infectious Disease at the NIH. He joi ned us in early
February, when still so little was known about COVID - 19, how
it ’ s spread, how deadly it was, and how it would impact life
here in the United States . I think we look back and say maybe
Dr. Fauci was cautiously optimistic at that time that we could
get a control on this pa ndemic, and then life moved on.

Dr. Anthony Fauci: W e know for sure that people have asymptomatic infection.
We also know from anecdotal reports that are solid that there
have been well documented instances of people transmit ting
the infection when they are asymptomatic. Now, what we
don't know is the full extent of what the asymptomatic
transmission is to the kinetics of the outbreak. Is it a major
driver of the outbreak or is still symptomatic people the major
drivers?

When you look at influenza, clearly, the major driver of
influenza are people who have over t clearly recognizable
symptoms. Right now, the big unknown is that the
phenomenon of asymptomatic transmission we know exists,
but to what extent does it exist , b ecause that's going to totally
impact how you screen people . I t's going to totally impact the
scope of the outbreak so that there'll be people out there who
have no idea that they're infected that might be infecting
other people. W e need to learn that really quic kly.

Mark Masselli: It's amazing how little we actually knew about COVID at that
time, Margaret . W e had emergency medicine doctors in New
York Times writer Dr. Sheri Fink join us in March, worrying that
the lack of testing infrastructure for COVID was goin g to put a
real strain on the health system. Ironically, a documentary she
co - produced was airing on Netflix at the time Pandemic - How
to Prevent an Outbreak . It literally coincided with a real
pandemic.

Dr. Sheri Fink: T he docu series Pandemic , which is o n Netflix, you said it's
prescient , but in some way -- one way to look at it this is the
whole reason we made a series about pandemics is because
that risk is a ll the time here with humanity.

Margaret Flinter: Sure.

Dr. Sheri Fink: W e hope that when peopl e watch that they see we have a
variety of people on the frontlines that are there all the time
kind of trying to prevent these new viruses from jumping from
the animal kingdom to the human , animal . T hen from thereon
what we do, and sort of the commonaliti es all around the

Mark and Margaret look back at 2020

world with the challenges and the benefits the wonderful ways
that people work together to try to limi t the suffering and the
damage.

I n terms of the disruption, again, those are difficult choices.
When do you shut a school? When do you s hut a workplace? I
think what I hear public officials saying now is that we need to
start thinking, even if the virus is not currently circulating in
your local area, you should start thinking about stocks of food
at home, in case you have to stay home for a while , not major
amounts . I've heard a couple weeks, perhaps just having dry
goods , and it's always a good thing anyways to have that.

If you're somebody who relies on medications, making sure
you have an extra amount of that just in case , and that coul d
just be supply chain disruptions, other reasons why it might be
difficult to get medications, for example . J ust thinking about
what you'll do if you have kids and their school is canceled.
Thinking about how you might be able to telecommute if you
can , s o those are definitely concerns.

Margaret Flinter: We were facing so many problems simultaneously around
COVID - 19 , and one of the areas where some people really
stepped forward with a focus on the data . There was a young
entrepreneur named Tomas Pueyo , who developed a very
compelling data analysis of the global outbreak early on
tracking the countries that were doing very well in terms of
containing the virus . His subsequent article, The Hammer and
The Dance , gave us an analysis of what we had to do in the
United States if we're going to be able to contain the virus .

Tomas Pueyo : The hammer is this very blunt force that you apply
indiscriminately. A scalpel enables you to be much more
precise on exactly what you need to do. First, you need to test
everybody because if you don't test, you don't know who is
infected. If you don't know who is infected, you cannot isolate
them to prevent them from being infectious. T hen you also
want to see all the contacts they've had over the last couple of
weeks so that you ca n isolate them, or you can put them in a
quarantine, you test them to see if they’re positive, if they are
positive then you isolate them , and if not you ask them to stay
home for a couple of weeks, so that even if they are
symptomatic they can’t tran smit the virus to anybody else.

If you do this, you can isolate only a few people and enable
everybody else to go back to work. But those are not easy
things to do. We all know that our testing is not at the right
level . We know that our contact tracing is basi cally non -
existent. W e need to set up these things. The question is not

Mark and Margaret look back at 2020

we've already been in lockdown , a re we ready yet? But rather,
what measures are we taking , and when are these measures
going to be ready for us to [inaudible 00:07:49] . For example,
ev erybody should be wearing masks, even a homemade
masks , make a huge difference. It is a no - brainer , j ust
everybody should be doing this. All of these things are pretty
cheap to do, a nd we should be doing them all.

Mark Masselli: W e've heard from so many of our guest that we should have
had a national strategy. But we had a 50 - state strategy and
maybe more than a 50 - state strategy because you had a lot of
cities breaking off on their own because there wasn't
centralized decision making. We had so many great guest on
Harvard Public Health e xpert , Dr. Ashish Jha shared his
assessment of the federal government's bungling of the
COVID - 19 response, which at that time, he joined us in May,
we had already lost 90,000 deaths .

Dr. Ashish Jha: T his really has been a re ally quite an unfortunate response by
our federal government. I think it's sort of borders on a
disaster , just really badly handled . I f you ask the question,
w ell, why do I use strong words like that? What does that
mean? One of the things that we've learn ed from almost every
disease outbreak, but boy, this virus more than most is that if
you fall behind, and if you don't take it seriously, it is a
punishing virus . A lot of people have gotten sick . A s of right
now, more than 90,000 Americans have died , and I think much
of it was preventable . Wouldn't it have been hard? T he answer
is yes, it would have been hard to prevent those 90,000
deaths.

W hat should have happened is we should have developed a
testing scheme early by kind of mid January, WHO had a te st
k it, we could have used that. When we tr y to develop our own
and it didn't work, we should have moved quickly to
harnessing the private sector. There are lots and lots of
opportunities . We basically wasted about six to eight weeks
not developing a test , and two months is a long time to lose in
a pandemic. T hat was really the original sin in many ways, and
driven partly by bureaucratic incompetence , but a lot by
leadership at the White House that didn't want to see testing
that really saw testing is somehow a n enemy because it would
reveal the number of cases we had .

One of the things I've tried to point out , testing doesn't give
you cases . The virus gives you cases . Testing helps you identify
them and do something about it. I nstead of dealing with the
fire, w e put it under the bed and hoped that it would go away ,

Mark and Margaret look back at 2020

and now the entire bed is on fire .

Margaret Flinter: We've just seen it over and over as holidays and events came
up , a n d we just couldn't seem to keep control of the situation .
I think it was also in May that we welcomed Former US
Surgeon General Dr. Vivek Murthy, who's been tapped by
P resident elect Biden to fill that role again, which is very good
news I think. He had already been concerned about some
other American h ealth s courges and while COVID d ominated
the scourge of loneliness and addiction, was also taking its toll
on the American people . H e talked about how this pandemic
would only amplify these already existing huge prob lems that
we were dealing with.

Dr. Vivek Murthy: Well, I do think that is pulled back the curtain on what is
broken in our healthcare system and in our public health
infrastructure. Long before COVID - 19 was on the scene, we
had been under investing . I heard as I would travel across the
country from State Departments of Health that would say, ou r
budgets were cut dur ing 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 healthca re comes
at a tremendous price.

I think that this is our opportunity to re - imagine what the
health infrastructure of 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
important from Sentinel S urveillance systems, to also the kind
of preventive measures and programs that we know w e need
to help reduce the risk of diabetes and obesity and heart
disease. During those times, we're not investing the resources
that we need. I t's our chance now, though, to think about how
we fund outbreak responses, about how we build really
modern age t echnology . I t 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 respecting
privacy.

Mark Masselli: But you know, we witnessed another brutal reality this year
the murder of George Floyd a t the hands of the police, which
sparked a massive outcry against entrenched racism in this
country. T he Black Lives Matter protest spr a ng up around the
country. We were fortunate to have House Majority Whip,
Congressman James Clyb urn join us to talk about his

Mark and Margaret look back at 2020

dedication and decades of work in the Civil Rights Movement
and how this moment of 2020 had brought us to this inflection
point.

James Clyburn: All of a sudden now I see Senator Mitt Romney marching in
the streets in Washingto n DC and mouthing the words, I'm
here to make it known that b lack l ives m atter . None of us , I
don't think there's a single soul that have thought two years
ago, they would see that phrase become a rallying cry, not just
across America, but around the world . I think this lynching ,
and that's what it was , of George Floyd, I think that opened a
lot of people's eyes.

When you see it, one picture is worth 1000 words. That
picture spoke loud enough. That's why I have been saying we
cannot allow this effort t o get hijacked with the effort back in
the 60s got hijacked. That is one thing John Lewis and I have
talked about a lot. We were founding members of the Student
Nonviolent Coordinating Committee, and we talked about
oft en as to how that got hijacked.

We woke up one morning after doing great work , all of a
sudden burn baby burn , all the headlines frighten people
away. This time, someone is a tried that again, with defund the
police. Nobody wants to defund the police. What we want to
do is bring attention to the f act we need to reform policing .
We got to re - imagine what policing is all about. We got to get
away from the slave patrols, which gave rise to what we now
call policing. I think people are beginning to talk to each other,
talk with each other, giving great meaning to that motto that
we use “ E Pluribus Unum, o ut of many , one. ”

Margaret Flinter: I do think back to sort of midsummer racial tensions were
flaring all across the countries. T he pandemic never really
slowed its march . We had Dr. Zeke Emanuel joined us then in
July and warned that this ongoing lack of a national response
was going to lead to really bad outcomes.

Dr. Zeke Emanuel : We have not had the leadership that we should in
Washington . We needed leadership that w ould look at every
component along the way, adequate PPE , adequate hospital
beds, adequate ventilators, creating a vaccine , supply chains
for testing, creating an army of contact tracers . R ight now we
need to be getting ready for actually deploying vaccines, no
preparation done. W e have ha d a lack of firm leadership.

The President has been obsessed by the economy, the stock
index, the Dow Jones, but those are not going to respond well
unless we actually have a response to COVID. I mean, people

Mark and Margaret look back at 2020

tell you in polling over and over again, and al so by their
behavior, yes they're cooped up. Yes, the monotony is killing
them. But they also are not going to fully engage in economic
activity, sending their kids to school, going back to the office
unless they feel safe. Right now, it's hard to feel saf e in alm ost
every state in the country.

Mark Masselli: A s tragic as the pandemic outcome has been, Margaret, there
has been a remarkable explosion of scientific discovery around
the disease . I t's been heartening to watch this global
collaboration of commit ted scientists coming together to solve
this big collective global problem. One such scientist is Dr. Eric
Topol, who is a Digital Health e ntrepreneur said that
something as simple as a wearable fitness tracker could be an
amazing tool for population healt h surveillance during the
pandemic .

Dr. Eric Topol : Right. Well, let me first start off with two technologies that I'm
very excited about because I am remaining optimistic. Firstly,
you touched on the fact that 100 million people in America
have either a s mart w atch or a f itness b and of some kind . It
gives heart rate and physical activity. Turns out, that's a very
crisp signal to be able to pick up COVID - 19, as we already
published for flu earlier this year.

W e adapted an app called the Tech Study , and we h ave 40,000
Americans , every state is covered, although we need hundreds
of thousands to do better. F atigue is a very important part of
COVID, early COVID - 19 , as is a resting heart rate . F atigue is
subjective , b ut when you're sleeping more and you're having
less physical activity, along with a resting heart rate that
increases, you can now get a diagnosis at least in a gro up and
a cluster is likely. T hat technology we think is really vital
because if we get into Digital Surveillance , it's very
complimentary to testing because testing you can't do in 330
million people on a frequent basis, you have a one off
measurement whereas a s mart w atch that people have or
f itness b an d , all they have to do is put it on , you have a way to
have surveillance of the country.

Germany has already initiated that in over 560,000 people .
They call it the national fever curve , and they can look
anywhere in the country to see if there's anything lighting up.
T hat technology is exist today. It's basically ju st analytics and
participat ion. Now the second technology that I think is
coming in the next couple of months, which is t ransformative ,
or the rapid diagnostic test . These are 15 minutes, pretty darn
accurate, relatively inexpensive, even down to a dollar and no

Mark and Margaret look back at 2020

less $5 , and you get the answer like on a paper strip, just like a
pregnancy test and then you know you're good for the day.
T hose are two technologies that have nothing to do with drugs
or vaccines .

Margaret Flinter: You know, along with the scientist which I think really to ok
center stage as people that we admire for their ability to
create a solution to this problem with the vaccine. We've also
admired some very smart, very dedicated journalists, who
have been a lifeline of accurate information around what was
going on. New York Times Reporter A poorva Mandavilli is one
of a handful of the prolific chroniclers of COVID information .
S he joined us to talk about the unique challenges of covering
the science around this emerging pandemic, and also about
the awesome responsibility of vetting information that the
public desperately needs and really making sure we're sif ting
out fact from fiction.

Apoorva Mandavilli : There's so much concerted attention being paid to this
c oronavirus right now and so many brilliant people working on
i t that we will uncover some insights that will translate to
other diseases. For example, the airborne transmission that
we were talking about, that's not just true for c oronavirus ,
t hat's also true for influenza . T here are experiments that were
never reall y done with influenza, but now because of the
urgency to do them for the c oronavirus , we a re learning a lot
more about the flu virus and how that is transmitted by air.

Similarly, there will be insights we'll gain from vaccine studies.
We're learning a lot more about the seasonal c oronaviruses
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 et, they cause most of the common colds ,
about 30 % of common colds , and so it is important for us to
know how they operate.

They're also just infectious disease insights into immunology . I
think the general public is learning a lot more about how our
human body works, how they respond to infectious disease
works. I mean, I did not rea lly think that I would be able to use
the word plasma blast in a New York Times story , and yet
that's what I'm able to do because people want to understand .
P eople want to understand what antibodies are, what the
virus really means, what all of these thing s 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 sor t of
share in that common knowledge.

Mark Masselli: Well, in that pursuit of having all the views and we invite d

Mark and Margaret look back at 2020

many Trump Administration officials to come in, we were
fortunate to welcome the Center for Medicare and Medicaid
Service Administrator Seema Verma to the show in
September . She offered her views on what they had done in
terms of the rapid adoption of te lehealth and other protocols
to meet the challenges brought on by COVID - 19. I would say,
this has been one of the more remarkable positive benefits, if
you will, if there's any way to say there's a positive benefit. But
it has been the adoption of teleheal th . I think it will have a
long term impact on saving lives, not only in the United States ,
but all across the globe.

Seema Verma: When it comes to telehealth , again, this was something that
fortunately the agency had already been wor king on before
the pan demic h it . We ’ve recognize d that Telehealth was in an
area, one of our strategic initiatives is fostering innovation ,
and one of the things that we've tried to do is to make sure
whether it's in the Medicare program that we're doing
everything we can to fo ster innovation across our country , and
telehealth was a great example of this. When the pandemic
hit, we tried to do everything we could to expand telehealth
and it wasn't just identifying services, we actually increased
the number of services . There's no w 135 services that can be
provided.

We also got rid of barriers to make sure that different types of
providers could use telehealth and can provide services. There
are also barriers in the program that restrict the number of
visits. F or example, in nursin g homes, you can only do one
telehealth visit a month and we recognize that obviously it
wasn't going to work. We've also made sure that it can be
provided in different settings , so again just trying to get rid of
all of that red tape around telehealth .

As I travel across the country, I'm hearing across the board,
how valuable people feel telehealth has been . From providers,
they're saying, look this isn't going to replace inpatient care,
but it's certainly something that can augment it, recognizing
that th ere's a lot of benefit, certainly convenience . I n the case
of a pandemic, it's actually protected our patients and
prot ected our healthcare workforce.

The one -- a few areas where I think it's particularly helpful
and that's in mental health. As we are see ing more in - person
visits return , the one area where we continue to see many
visits is in mental health and a lot of people just feel more
comfortable doing that via telehealth . It reduces the stigma.

Margaret Flinter: T hen the calendar turned again, we we re into the fall, still

Mark and Margaret look back at 2020

hoping for a slowdown in the rise in the number of deaths. But
Dr. Fauci rejoined us then just when the daily infection rates
were spiking again, and he warned us if people traveled for
Thanksgiving, we were going to see some devast ating
outcomes , and he was right.

Dr. Anthony Fauci: Well, first of all, we are in a precarious position because I
would have hoped that as we enter into the cooler months of
the fall that the baseline of daily infections would be very low ,
well below 10,0 00. In fact, they range between 40 ,000 and
50,000 per day. In addition, if you look at the map of the
country , somewhere between 30 and 37 states are having an
increased uptick in the test positivity, which is a very accurate
predictor of a surge in new ca ses, which already is showing
itself in certain areas with an increase in hospitalization, and
even an increase in deaths . E ven though the total deaths come
down in certain areas of the country , we're seeing
hospitalizations and deaths go up. That's a very precarious
situation to find yourself in as you enter the fall and the winter
months.

W hat we need to do is we just have to double down on some
of the things that we' ve been talking about all along. The five
fundamental public health measures, universal w earing of
masks, avoiding close contact, avoiding crowds and
congregate settings, doing things more outdoors than indoors,
and washing your hands frequently . I f we just did those simple
things, we would mitigate greatly this risk of having a yet again
anot her surging of cases as we enter into the cooler season.

Mark Masselli: Well, it was so good to have Dr. Fauci on two times during the
pandemic . I think we learned so much from him and we
learned also from renowned infectious disease expert, Dr.
Michael Os terholm , who joined us in December, the author of
hundreds of publications on infectious disease, including the
2017 book, The Deadliest Enemy . He's a member of the
President Elect Biden's COVID - 19 Task Force , and he really
warned us that as promising as t he vaccine uses, we really
must adhere to strict public health protocol, and getting a
large sector of the population to take the vaccine remai ns
another challenge, Margaret.

Dr. Michael Osterholm : Operation Warp Speed brought us vaccines, but will they br ing
us vaccinations? I think this is where we have fallen down and
we need to really get up and catch up very quickly , and that is
how do we help the public understand what these vaccines
are all about . We have many people today that are highly
skeptical o f the safety of these vaccines thinking that based on

Mark and Margaret look back at 2020

the name of what's happened that there are huge safety
issues , and that's not just true for the general public. I've
heard this over and over again from medical care providers,
who they themselves say, w ell , maybe I'll wait a little while.
Well, right now, we have almost 2 , 000 people a day dying
from this disease. We can't wait for five, six, seven years to get
better data , and we’re going to have to make some tough but
really informed choices over the c ourse of the next few weeks
to decide, are these vaccines what we need to do ? I'm
confident they are the ones we want . I can't wait to get in line
to get mine when it's my turn.

But in the meantime, we need an extensive effort of outreach
to first of all, to our medical care community so that they have
the facts that they are not misguiding their patients by
providing incomplete or not accurate information. Second of
all, we have to reach out and involve the communities most
impacted by this which are namel y the black, indigenous and
communities of color. We have to involve them and help them
be the leaders in their own commu nities to get this vaccine
out.

Margaret Flinter: Well, I think one of the lessons that we've had over the years
is no matter what the threat, we always see that there are
great minds and committed people toiling on the frontlines to
advance health and well - being of all people . T hey're doing it
through science and a commitment to public health, and a
general just commitment to their fello w human beings.
President Biden has promised to make COVID - 19 priority one,
and we look forward to seeing the new approach of his
administration and his team to help us carry through what
now appears to be the point at which we can see a light at the
end o f the tunnel, there's still hardship to come.

Mark Masselli: But we were fortunate again, to have so many guests, the
people who are committed in fighting for health equality, and
equity and justice, all of whom are seeking new ways to
st
i mprove healthcare f or the 21 century . We are always
pleased to welcome these great minds to our show so t hat we
can share them with you.

Margaret Flinter: A s we embark on 2021 , we are so looking forward to the day
when we are looking back on this pandemic tragedy. The
less ons that we've learned from it , celebrating the science and
the perseverance that got us through it even while we mourn
those that were lost or those that were hurt and injured by the
pandemic. But we hope it inspires a whole new generation of
young people who are interested and passionate about

Mark and Margaret look back at 2020

science, about healthcare delivery, about public health, they
have proven to be our greatest heroes in this time of trouble .
It is a tremendous thing that we've seen such an outpouring of
support and interest for th ese people on the frontlines, not
just of healthcare, but certainly of healthcare and of science
and of publi c health and community leaders.

Mark Masselli: On behalf of all of us here at Conversations on Health Care , we
want to extend our happy h olidays to all of you out there , s tay
s afe . When it's your turn, please consider taking the vaccine.
Thank you all and best wishes.

Margaret Flinter: Happy New Year.

Mark Masselli: Peace and health.

[Music]

Mark Masselli: You’ve been listening Conversations on Healt h 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
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