Omicron’s Health Inequities: N.Y. State Health Commissioner Vows to Close Gap

Dr. Mary Bassett

[Music]
Marianne O’Hare: Welcome to Conversations on Health Care with Mark Masselli and
Margaret Flinter . This week we welcome New York State Health
Commissioner , Dr. Mary Bassett , on shifting public health protocols
for the next phase of the pandemic .

Dr. Mary Bassett: We have lifted the requirement that all people be masked or Vaxxed
in public indoor spaces . We continue to recommend masking.

Marianne O’Hare: Lori Robertson joins us from FactCheck.org and we end with a bright
idea that’s improving health a nd wellbeing in everyday lives. Now,
here are your hosts Mark Masselli and Margaret Flinter.

Mark Masselli: Our guest leads the health department in one of the largest and most
diverse states in the country. She brings to this role an incredible
background on the frontlines of health here in the United States and
around the world and has often tackled deadly diseases such as Ebola
Legionnaires disease, and now , of course , COVID.

Margaret Flinter: Dr. Mary Bassett is the New York State Commissioner of Health . She
previously led the New York City Department of Health and Mental
Hygiene and most recently served as the Director of Harvard's FXB
Cen ter for Health and Human Rights.

Mark Masselli: Dr. Bassett, Welcome to Conversations on Health Care . We start with
the sad news about the passing of Dr. Paul Farmer, a Global Health
Champion and Founder of Partners in Health. You were strong ally in
his efforts , and so we'd like to ask you for your reflections?

Dr. Mary Bassett: Well, obviously , we’re all stunned at th is news . Dr. Farmer was only
62 years old. The last time I saw him was in Butera, Rwanda, where he
died at a School of Public Health that he had established to offer
frontline Public Health Training to people from all around Africa , and
this was , I don't k now , how many chapters he'd had , but this was yet
another one of higher education. So he was an incredibly charismatic
figure. I think we can credit a whole generation of young people who
went into global health because of Paul Farmer . He always was
outspo ken , the need to protect the wellbeing of people who have
been left behind all over the world. I just can't believe it really . He had
three children , and I'm just so sorry that we've lost him . He had so
much more to give.

Margaret Flinter: Well, thank you so much for those words, Dr. Bassett, and I will tell
you we share I think as a country in the loss of just a tremendous
person. I want to turn to COVID to ask you about the latest details
about COVID and Omicron . Your S tate has lifted his mask or Vax
indo or mandate for businesses , cases and hospitalizations are way
down. But share with us how you think it's going in your incredibly
diverse S tate as well from very urban to rural areas .

Dr. Mary Bassett

Dr. Mary Bassett: I became Health Commissioner on December 1 , and our fi rst Omicron
case in New York State was identified on December 2 and all of us
were amazed at the rapid spread of Omicron. That spike became a
signature of Omicron and in New York State, we were clocking in over
90,000 cases a day in the first part of Janua ry . I'm pleased to say that
we've been coming down steadily , and the most recent data show
that something between 2% and 3% of people who get tested are
testing positive . We've been up tenfold higher at the peak of the
pandemic. So we're on the downside . W e have lifted the requirement
that all people be masked or v a x xed in public indoor spaces, we
continue to recommend masking and of course, we very much want
everyone who hasn't been fully vaccinated to become vaccinated and
to get boosted. Our coverage is now at about 75%, New York State is
doing much better than many other S tates. But we st ill need to be
higher than that of the group in which we have the furthest to go are
children for a long time we were under 30%. But , you know, that still
remains low. T his is for the 5 to 11 year olds . It's higher in the older
age groups. We still have masking required on public transport and in
hospitals, nursing homes, but no longer as you say in public indoor
spaces.

Mark Masselli: Let me pull the thread a little on y oung people and you have lots of
difficult decisions in front of you. When do you think the S tate will be
getting closer to ending mask requirements for students and schools?
And really, what's the timing on the decision? Any news you want to
break today? We welcome it.

Dr. Mary Bassett: I will say what we have been saying is that we use a number of
different metrics. Of course , we use cases that's the number of people
who test positive. That metric is challenged. I could say by the fact
that we have more a nd more home tests . We've sent out the door
close to 35 million tests. So we aren't capturing as completely the
people who are testing positive as we used to. Nonetheless, the
direction of cases is helpful and we consider to see them decline.
Hospitalizati ons are something that we look at carefully , and those
are going down rapidly. So everything we look at is going in the same
direction , and that's very hopeful. But compared to our low , in the
summer of July, August of last year, we still have four times a s many
people in the hospital now than we had back then. So the G overnor
has said, when the kids come back from school, we'll have them
returning with that, we hope, having performed home tests, and we'll
look at all of our numbers and where we stand then and make a
decision about masks in schools. So we're looking at a whole array ,
and I should add one more thing, as speaking of a Global Health Giant
like Paul Farmer, that he's taught us that we have to keep in mind the
whole world , and of course, we keep an eye out for any other
variants.

Dr. Mary Bassett

Omicron went very quickly, it was sort of announced to the world on
Thanksgiving Day , and we had our first case in New York just shortly
thereafter, and the rest we've all witnessed. So we're also keeping an
eye on the e mergence of other variants . We would be concerned that
we have protections in place in advance of the arrival of a new
variant.

Margaret Flinter: Dr. Bassett, it's clear from your comments that you're keeping a very
close eye on many, many data streams to inform decision making. But
the New York Times recently reported that CDC hasn't been sharing
all the pandemic data that it has with health departments like the one
you lead. And then they said that the data collection is small and
could be misinterpreted. But do you feel like you're getting all the
data that you can from the CDC, as well as any other national
sources ?

Dr. Mary Bassett: We have a lot of data here and we have been contributing to the
national conversation about vaccine protection. As you kno w, we
have a wonderful group of data scientists who've been looking at the
protectiveness of natural infection and vaccination. December 24,
Christmas Eve, we released information about the much more rapid
rise of hospitalizations among children. We also h ave wastewater
data . We are collecting it now in five counties . We have received
funding to extend wastewater surveillance to the entire S tate , and I
have not heard this about the CDC. We all look to the CDC for data
and for guidance. But of course, it is true that during this pandemic ,
S tates have occasionally had to make decisions that were out ahead
of the CDC. New York State has done that as have other S tates. That's
because we look at our data and tried to decide what's best for t he
people who live in our S tate.

Mark Masselli: You know, you've taken the lead on addressing what's called Long
COVID. New York State has brought together an expert group of
researchers, clinicians, social scientists, and other stakeholders to
share their expertise and insight on this condition, the data seems to
be a little scary in terms of the effect that long term COVID is having
on people who might have had mild symptoms, but are facing a whole
range of health conditions.

Dr. Mary Bassett: That's right , and it's really imp ortant that you raise this because there
is especially with Omicron, a sort of sense increasingly that Omicron
sort of not bad worse than a bad head cold , and we should all st op
worrying about getting COVID, now that it's the Omicron strain, and
we don't k now yet whether the Omicron variant is associated with
Long COVID. But I would expect that it would be . So we convened a
group of really wonderful group of scientists, clinicians, people living
with COVID, one of the things that we are looking to this grou p to is to
try and give us guidance as a health department and what our role

Dr. Mary Bassett

might be. The NIH has the role and the resources to fund big studies ,
and they're doing that because it's clear that even when Acute COVID
is over, there are going to be people wh o are living with Long COVID
and it can be people who d idn't even have symptoms at all, weren't
aware that they'd been infected, as well as people who had mild
symptoms, people who were completely fit and it seems to be sort of
analogous in ways to chronic fatigue syndrome. But the science is still
evolving. It could affect a fairly large number of people. Some studies
suggest that up to a third of people may be affected with protracted
symptoms. But it's clear that this is real. Many of the people who have
it had encountered skepticism on the part of their health care
providers.

Mark Masselli: And obviously it has an enormous impact on how one thinks about
the health care system going forward and the additional demands
that will be put on it.

Dr. Mary Basse tt: Exactly.

Margaret Flinter: You know, Dr. Bassett, I think you probably have to spend 24 hours a
day, focusing on COVID, and then in the other 24 hours a day , keep
thinking about everything else that was there before COVID. I wonder
if you could share w ith us the major health issues that you see facing
your S tate at this point in time. Behavioral health issues are p robably
right there on the list, substance abuse , maternal mortality, but tell us
what you're zeroing in on?

Dr. Mary Bassett: Well, one of t he things about the New York State Health Department
that is really kind of unique is that it has real in - reach into the
healthcare delivery system . All of the things that we consider
traditional public health, and an important role, for example, in
addres sing non - communicable diseases, which will remain the leading
causes of deaths as COVID recedes and so we still have to work on
with the advent of E - cigarettes, we have youth tobacco use back up at
levels that it was 20 years ago . We have the problem of un healthy
food and the overweight and obesity and diabetes, which in many
ways COVID really uncovered the failures of our system to keep
people healthy. You mentioned maternal mortality , and that, of
course, is one of the many conditions which shows a huge r acial
disparity in the occurrence that far more likely to have an adverse
event as a pregnant person, if you are classified as African American.
In New York City, this was one of the biggest racial gaps that I ever
saw 12 to 1 higher risk of deaths related to pregnancy and delivery for
African Americans.

So yes, we will be continuing to work on reproductive health issues,
thinking through what we will – how we will respond as a S tate that
has always given women trust in the event of a loss of row. And then
there's a whole other side of the agency where we oversee Medicaid,

Dr. Mary Bassett

which provides a health insurance coverage for nearly a third of New
Yorkers and figuring out how to bring closer together primary care
and more traditional public health. So those all re main really the
things that inspire me in public health. But of course, we have to be
ready for the next emergency , and that's going to be likely include
microbial threats, but also weather emergencies, climate change to all
of it, I will bring an equity l ens and that remains the sort of the North
Star of my working life as a physician committed to public health.

Mark Masselli: Not only are these some challenges, but we're also seeing challenges I
don't think we've ever seen before. Republicans now in other S tates
are using Dr. Fauci in a negative way in their midterm campaign ads. I
don't think we've ever seen a public health official positioned as a
political weapon like this before, what will it mean to the public
health profession?

Dr. Mary Bassett: And this has been a really difficult period for government public
health. Maybe a year ago, the Kaiser Family Foundation did an
analysis that showed that 150 S tate and local public health leaders
had either left – had left their jobs either voluntarily or had been
fired. So it's been a real hollowing out of government health
departments because of the politicization of the COVID response. It
began during a period when we had an administration that was really
embraced scientific skepticism. So it's been a diffic ult time . Dr. Fauci is
a national treasure in my opinion and he has continued to forge into
the muddy waters to defend science. It's worrying, but a lot of this is
not about facts. It's about trust and we have a really big job to do to
rebuild the public's trust in public health and government more
generally, and as you probably know, Governor Hochul has made it a
priority to rebuild trust and I hope that we do that by telling people
the truth, making clear that we will not hide things from people , and I
th ink Dr. Fauci does all that and it's really regrettable that he's coming
under personal attack . He has bodyguards . His family members have
to have bodyguards.

Margaret Flinter: But you are a very visible public health leader that one of the big
challenges that seems during COVID is we always want to follow the
science in health care and public health. But sometimes we didn't
have all the information we needed to know just the science wasn't
catching up with the reality on the ground.

Dr. Mary Bassett: That' s right.

Margaret Flinter: How did you learn to balance the science and the political
considerations with so much going on? Share a little bit about what
that journey has been like this year .

Dr. Mary Bassett: Well, you're right. I mean, COVID has really t aught us to cope with
uncertainty , and part of our problem is that our understanding has

Dr. Mary Bassett

changed , and the virus has changed, so people feel like they were told
things that have no longer held up . They were told if they got
vaccinated, they wouldn't get COV ID. Now we know that's not true.
We saw people – we’ve seen people get COVID more than once , and
that's related to the waning immunity, which we have learned about,
and to a changing virus, which unfortunately, will continue to change
as long as we fail to get vaccine to the whole world. So I try to tell
people what we know , what we don't know, people can cope with
uncertainty . We all do to sort of act as though we can only share
things that are incontrovertibl e, won't work.

I've only been at this for two and a half months so I think that it's
been a good time for more openness at the department where I have
much better lines of communication with New York City than there
ever were in the previous administrations. So maybe also seeing less
infighting will h elp people have a little more confidence in us.

Mark Masselli: Well, you’ve only been at that job for two and a half months. But you
have a long history of international health work and your extensive
experience working in Zimbabwe on AIDS treatment . There are a lot
of theories about why Africa has been spared from the worst of
COVID death toll. What's your thought about what's happening there?

Dr. Mary Bassett: Well, the first thing is, I think it's true that everybody thought that it
would be a catastroph e in Africa, as the health systems are very
fragile , the vaccine, as you know, has reached a very sma ll proportion
of the population. E ven in a wealthy country in Africa, South Africa . I
don't think more than a third of people have been fully vaccinated.
A nd yeah, we haven't seen the mortality impact , and we would s ee
that the way we saw with HIV, by looking at the graveyards, literally . I
remember going during the height of the AIDS epidemic, to
cemeteries and you would just see a line of grave diggers bur ying one
person after another and the newspapers, the photographs of people,
in the prime of life who had died. We have not seen that with COVID.
One reason may be that people spend a lot of their lives outdoors ,
and it is true that there's no t as many pub lic indoor spaces.

Another hypothesis and I don't know how we would prove this is that
people get a lot more infections and had a more kind of revved up
immune system. Thank goodness, it seems to be true that Africa,
which has paid so many high prices, Af rica had the worst AIDS
epidemic in the world, that maybe with COVID, they didn't pay as
much . So I don't have an answer. There are people who think that the
Omicron variant may have had the chance to sort of survive in an
immunocompromised person, and you take multipl y in that person
and that's why we got such an unusual number of mutations in the
variant , but it was related to the fact that many people in Southern
Africa are living with HIV.

Dr. Mary Bassett

Margaret Flinter: Commissioner Bassett, you spoke a few moments ago about the
degree to which health equity has really guided your work. We're in
Black History Month. What more is on your agenda specifically about
the degree to which structural racism has caused such health gaps
between whites and communities of color?

Dr. Mary Bassett: Well, of course, you see these gaps in virtually any outcome . We saw
with COVID, the Omicron variant, I think many people thought sort of
swept like wildfire and affected everyone equally. But in New York
State, the hospitalization gap b etween African Americans and people
who are classified as white went up to two fold. And you mentioned
structural racism , and it's a phrase that practically didn't exist in public
health until the past couple of years and now we use it a lot , and what
we m ean by that is the ways in which racism works that don't require
personal prejudice. A key example of that is Redlining . You know,
people may say, Well, what does Redlining have to do with health ,
and if viewers aren't familiar with this, this was a progra m by the
government in the 1930s as part of recovery from the depression, to
make homeownership more accessible to Americans , and they
created in over 50 states sort of credit worthiness of neighborhoods
and routinely, African American neighborhoods litera lly had red lines
drawn around them, that deprived them of credit worthiness, and
made them victims of predatory lending practices. And in the
neighborhoods that were redlined so many years ago, the infant
mortality rate remains three or four fold higher t ha n it is in other
neighborhoods.

So this is an example of structural racism. If your neighborhood was
redlined, you were not getting that government back mortgage , and
that, of course, had real knock on effects. Owning a home is a
principal source of int ergenerational wealth transfer, and deprived
African American commun ities have access to this asset. It wasn't
forced not only by the banks, but by the real estate agents. So
Redlining is an example of how multiple institutions work to create a
wealth gap, which has translated into a persistent health gap. So
when we talk about undoing structural racism, this isn't a small
project. But key to it is always first having data. We , in New York
State , are still working on improving our data on race ethnicity. To be
frank, the city did a much better job of this. And then we have to look
at every all of our programs and say, are we targeting them to the
groups that need these interventions the most? It won't always be by
race, ethnicity, and estate. As you mentione d, we have rural
communities that are predominantly white, which have really been
left behind , and the opioid epidemic, for example, uncovered that .

Mark Masselli: Well, thank you so much for shining the light on structural racism, and
also your comments a bout Redlining . It reminds me of one of our
heroes, Dr. Jack Geiger, who early on in the community health center

Dr. Mary Bassett

movement really said the things that can improve the community are
bank lending practices. So thank you so much, Commissioner for
sharing your thoughts and insights. You can learn more about
Conversations on Health Care and can sign up for our email updates
at www.chcradio.com . Thank you, doctor for joining us today.

Dr. Mary Bassett: Thanks so much for hav ing me , and for such a wide ranging
conversation.

[Music]

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 journa list 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 Robertson: Neither primary vaccination nor natural i mmunity is generally
stopping infections with the Omicron variant, but research shows
booster doses substantially increase protection. Yet Republican
Senator Rand Paul claimed in a late January interview that a case of
COVID - 19 provides, “ An immunity bette r than the vaccine .”
Recovering from COVID - 19 is expected to confer some immunity from
reinfection just as getting vaccinated prevents symptomatic illness.
The Centers for Disease Control and Prevention says that several
studies have shown that prior infec tion or vaccination provide high
protection for at least six months against similar variants. Those who
wish to engage in a vaccine or natural immunity debate can find
studies supporting both sides. But the added benefit of vaccination is
to gain immunity without having to suffer through an illness, possibly
a severe one. And studies have found that having vaccination and a
previous infection, so called Hybrid Immunity provides even stronger
protection. Paul's office pointed us to a recent report from the C DC
that found prior infections conferred more immunity against the Delta
variant than the primary vaccination series. But assessments of
immunity depend on the variant and the study period was before the
highly mutated Omicron variant took over and before booster shots
were widely recommended.

Since late January, the CDC has estimated Omicron accounts for
nearly all the Coronavirus infections in the country. What's the
stronger immunity to ward off an Omicron infection? Booster doses,
w hether you've had a bout of COVID - 19 before or not . Research
conducted by Alejandro Valles, the Principal Investigator at the
Reagan Institute, and others found that people who had gotten a
booster dose of an mRNA COVID - 19 vaccine were making better
antibodies than those who had received only two doses, those who
had a natural infection or those wit h a natural infection and a two -

Dr. Mary Bassett

dose vaccination series. Three mRNA shots were better than having
t w o plus a prior infec tion or only a prior infection.

Another CDC study using data from 10 S tates when Omicron was
predominant, found vaccine effectiveness against COVID - 19
associated hospitalizations increased from 57% effectiveness to 90%
effectiveness at leas t 14 days after the third dose. That's my
FactCheck for this week. I'm Lori Robertson, Managing Editor of
FactCheck .org .

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 check, email us at www.chcradio.com . We’ll have FactCheck .org’s
Lori Robertson check it out for you here on Conversations on Health
Care.

[Music]

Margaret Flinter: Each week Conversations highl ights a bright idea about how to make
wellness a part of our communities and everyday lives. Mosquitoes
are considered one of the deadliest animals on earth, leading to
hundreds of millions of illnesses and some 2.7 million deaths per year
globally , and di seases such as malaria, dengue f ever, and Zika are on
the rise.

Dr. Scott O’Neill: This is one mosquito called Aedes aegypti that transmits a range of
different viruses to people . That include viruses like yellow fever,
dengue fever, Chikungunya , Zika, and the consequences can be very
dire.

Margaret Flinter: Dr. Scott O'Neill is the Director of the World Mosquito Program which
has developed an innovative appr oach to eradicating the threat.

Dr. Scott O’Neill: I was particularly interested in this bacterium c alled Wolbachia. This
bacteria is present in up to 50% of insects naturally, but not this one
mosquito that transmits all these viruses. When we put the bacterium
into the mosquito, the viruses couldn't grow any longer in the
mosquito. So we're seeding pop ulations of mosquitoes with our own
mosquitoes that contain Wolbachia . Once the mosquitoes have it ,
they're protected from being able to transmit viruses.

Margaret Flinter: Dr. O'Neill's team released the genetically modified mosquitoes into a
targeted are a and the results showed a dramatic reduction in human
infections .

Dr. Scott O’Neill: In Northern Australia , we deployed the Wolbachia over quite large
areas, entire cities, and we've seen essentially a complete elimination
96% reduction in Deng ue in those cities, and we would hope within 10
years, we could bring this intervention to 500 million people .

Dr. Mary Bassett

Margaret Flinter: The World Mosquito Program an effective targeted approach to
eradicating the threat of deadly mosquito borne pathogens, leading
to a drama tic reduction in harm to public health. Now, that's 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 .

[Music]

Mariann e O’Hare : Conversations on Health Care is recorded at WESU at Wesleyan
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