CDC Director Warns of More Dangers From Hurricane Helene

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Mark Masselli ( 00:05 ):
Hurricane Helene has left a trail of death and destruction across Southeast United States, most notably
in a state our guest knows very well.
Dr. Mandy Cohen ( 00:13 ):
It's going to be a long road to recovery. I want in the moment, make sure people are staying safe, stay
out of those floodwaters. It could be contaminated with pollutants.
Margaret Flinter ( 00:22 ):
Dr. Mandy Cohen is the Director of the Centers for Disease Control and Prevention and previously
served as the top health leader in North Carolina. We're talking to her today about the health impact of
this monster storm and also discussing why the country is lagging in COVID vaccinations so far this year.
Dr. Mandy Cohen ( 00:40 ):
Get one of those updated COVID vaccines because the reason you want to get the updated COVID
vaccine is the virus has changed.
Margaret Flinter ( 00:48 ):
This is Conversations on Health Care.
Mark Masselli ( 00:59 ):
Dr. Cohen, welcome back to Conversations on Health Care.
Dr. Mandy Cohen ( 01:02 ):
Great to be here. Thanks for having me.
Mark Masselli ( 01:04 ):
Yeah. We want to start off asking you about Hurricane Helene and the people affected by it. You have
strong ties to North Carolina. You previously served as that state's Director of Health and Human
Services. Can you share with our audience your thoughts and updates on the health situation?
Dr. Mandy Cohen ( 01:20 ):
Yeah. As a North Carolinian, my heart goes out to the western part of our state. It's going to be a long
road to recovery. I want in the moment, make sure people are staying safe, stay out of those
floodwaters. It could be contaminated with pollutants. Make sure that you're working with local, state,
and federal officials who are on scene to help. So I know it's going to be a long road, but know that we
are thinking of you and doing everything we can from across the federal government, state government,
local government to make sure we can recover as quickly as possible out there. But we know it's going
to be a long road.
Margaret Flinter ( 01:54 ):
Well, Dr. Cohen, we have North Carolina, Florida, Georgia, all under a public health emergency as we
speak to you. And I know that, as you just did, you're working to inform the public about the health

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dangers that still exist during the cleanup phase as well. What does CDC activity look like at this stage on
the ground and remotely?

Dr. Mandy Cohen ( 02:14 ):
Well, public health overall is in a supportive role right now. And we're still in the very acute phase of the
hurricane, so we want to make sure those who are in the response phase, making sure that they are
doing the lead work. We are always willing to support as we go, but we want to make sure we're giving
good recommendations. First, of course, stay out of those floodwaters. Make sure you're not driving
into floodwaters. Please be heeding all of the advice and recommendations of local officials. But then of
course, making sure that we know people had power outages which means food has spoiled in the
refrigerator. Make sure you're not eating spoiled food.
( 02:53 ):
Our water systems unfortunately in Western North Carolina I know have really gotten hard hit, so
thinking about whether you need to be on bottled water. So those are the kinds of messages in the next
couple of days. And then we get into recovery where we know it's going to be a long phase and we know
things like we are likely to see more mosquitoes because we'll see standing water. Making sure folks are
doing what they need to protect themselves with bug spray, trying to get rid of as much standing water
around as we can. I know that can be very hard in these first few days here.

Mark Masselli ( 03:27 ):
Let's just turn to another important issue. It's vaccination season for respiratory viruses such as
COVID-19, the flu and RSV. And according to the CDC, only 2.8% of adults have received one of the
updated COVID vaccines since it became available about a month ago. That seems to be a terrible
statistics and I'm wondering how can we do better this year?

Dr. Mandy Cohen ( 03:52 ):
Well, we're early in the season and this is exactly why I am joining the podcast today to get the word out
that the best defense that we can give ourselves, our loved ones as we head into the fall and winter is to
get an updated COVID vaccine, an updated flu shot. And if you're over 75, that RSV vaccine and for our
infants, an RSV immunization as well. So we have the tools, we need to use them. And I think we all
want to leave COVID in the rear view mirror, but it is still here with us. Last year there were 800,000
hospitalizations between COVID, flu and RSV. If we use these tools, we can cut that number in half. We
know that vaccines work to cut hospitalization risk in half, so we know it's a really important defense. I'll
be getting my COVID vaccine next week, I already got my flu shot. And so I wouldn't recommend
something for the American people I wouldn't do for myself. So I hope everyone's making their plan now
in October to get their updated COVID, flu vaccine and then RSV if it's right for you.

Mark Masselli ( 04:53 ):
Great advice.

Margaret Flinter ( 04:53 ):
Perfect. I'll be right behind you. My husband was there on Saturday. But Dr. Cohen, I think we've all
struggled over these years of COVID, how much information is important for people? And maybe this is
a little bit technical, but we know the Pfizer and Moderna COVID vaccines rely on the mRNA technology
that people in this country have learned so much about. There's also a traditional non-mRNA vaccine

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developed by Novavax. Can you explain the different options that are available this year to people and
why might they want to know the differences?

Dr. Mandy Cohen ( 05:25 ):
Well, I would say you don't need to know the differences, just get one of them. And so get one of those
updated COVID vaccines because the reason you want to get the updated COVID vaccine is the virus has
changed. Even in the last several months, even from the summer, we continue to see the virus change
and you want to get the most up to date protection and that is what this brings you. And just also, we
don't want to forget about long COVID. No one wants to be sick, but particularly not for a long time and
even a mild infection could cause symptoms and long COVID. So again, another way to proactively try to
protect yourself from long COVID.

Mark Masselli ( 06:03 ):
The CDC reported that four out of 10 nursing home residents had received an updated COVID shot since
last fall. And the report really blames the situation on vaccine fatigue. You talked about it in terms of
people want it in their rear view mirror, but it's not there, it's still right in front of us. And we're seeing
so much inaccurate health information and vaccine hesitancy. I'm wondering what other ways to
overcome these hurdles are out there for us. What other tools in the toolbox might we use to encourage
people to understand the lethality of COVID and hopefully direct them towards a primary care provider
to get their shot?

Dr. Mandy Cohen ( 06:46 ):
Yeah. Well, at the CDC, we still know that one of the most powerful voices is that of your own personal
doctor. And one of the main reasons folks didn't get vaccinated last year is they said, "Well, my doctor,
my nurse practitioner, they didn't bring it up, so I assumed it wasn't for me." And we have been working
really hard with the clinical community to not just make sure that they're recommending it, but to really
embed it in the workflow, from the time a patient checks in to putting out reminders. So to make sure
that we are bringing folks in to get those updated COVID and flu shots. And I've been talking to the
business community, many of them had in-office flu clinics for many years. Great, have those again and
add COVID. So if you're getting flu shots at the office, get a COVID in addition. Because remember, head-
to-head COVID still causes more hospitalizations and deaths than flu. So if you're used to getting that flu
shot every year, you definitely want to add that COVID shot, if you're over 75, RSV as well.

Margaret Flinter ( 07:47 ):
Well, children, Dr. Cohen, have been a particular concern of course with both COVID and flu. And I think
last year there was a drop in vaccinations and there was an increase in the number of children who died
from flu I understand last year. What are we doing to try and make sure that doesn't happen, that it's
both COVID and flu that we're really advocating for offices to provide or the pharmacy or the school or
wherever the kids are?

Dr. Mandy Cohen ( 08:15 ):
Yeah. I think we often forget because the highest risk group are those who are over 65, which is right for
both COVID and flu. We forget that our youngest kids are still at risk from COVID and flu. And
particularly we're seeing with COVID, when kids get very sick from COVID and go into the ICU, half of
those kids don't have underlying conditions. Meaning we can't predict which kids get very sick. Which is
again, why you want to get your kids vaccinated. So if they haven't had their primary series and now

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we're seeing more kids who were born too young to potentially get that first series, we really want you
to get that first series of the vaccine and then continue to do that year over year. Our little kids under
five, they have smaller lungs, smaller bronchioles, and can have these viruses overwhelm them more
quickly. So particularly our young kids and those who are over 65, we want to make sure that everyone
is getting their updated COVID and flu vaccines.

Mark Masselli ( 09:16 ):
Dr. Cohen, I was thinking as you were talking about Hurricane Helene and its impact in terms of standing
water and making sure that people get rid of those mosquitoes. The CDC has confirmed over 10 cases of
eastern equine encephalitis and a New York resident has died from the mosquito-borne viral illness.
What's the latest on the health risk?

Dr. Mandy Cohen ( 09:40 ):
So something to notice, EEE is a mosquito-borne illness, but very rare luckily in the United States. And
even this year, continues to be very rare. And we've seen about the same number of cases and deaths
that we've seen in the past. So I don't think we're seeing more than usual. Again, very rare, but there are
things we can do to protect ourselves, particularly if you're in the Northeast. You want to be thinking
about wearing bug spray, wearing long sleeves, and of course getting rid of standing water, which is a
place where mosquitoes can breed. So good to be alert for it and particularly wanting our clinicians out
there to have that on their thought list. If someone comes in with body aches and fever, to make sure
you're checking for things like West Nile, dengue and other mosquito-borne illnesses depending on what
part of the country you're in.

Margaret Flinter ( 10:30 ):
Dr. Cohen, I'm going to give you a minute's respite from flu, COVID and all things that are going on in the
infectious disease world right now. But I want to turn maybe to your experience over this last year and a
half. I think you're about a year and a half into your role as the CDC director. And we remember you
took office with one of your focuses being on restoring faith in the CDC. Tell us how that's going. What
are you satisfied with? What are you still working on?

Dr. Mandy Cohen ( 10:59 ):
Yeah. Well, I'm very proud of the CDC. I just came from an all-hands meeting, that means that all 10,000,
12,000 of our employees getting together to make sure that we are working together as one team. And I
hope everyone is seeing that. One, I think we are communicating in a different way. Communicating
faster, more concisely, and in a more simple common-sense way so that folks know exactly what are the
things they need to do in their lives to protect their own health and their family's health. Then I think
we're also turning our data into action more quickly. And importantly, we're learning some hard lessons
from the pandemic where we didn't have the infrastructure we needed, whether it was data or lab or
the workforce training, to make sure that no matter what comes at us in the future that we are ready for
it. But it does mean us working differently in public health as one team across disease states.
( 11:55 ):
So we have experts in malaria and experts in HIV and experts in COVID, but we need one data system
because we know our communities are experiencing all of that. We need a laboratory system that can
be ready to respond no matter the health threat, and that we can scale up testing if we need it very
quickly. And we need that response capability to really make sure that we are acting quickly. So I'm

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really proud of the progress we've made in that communicating differently, turning our data into action
and being ready to respond. So I hope folks are seeing that. I've been sharing a lot that when public
health is working, it's invisible. And we need to be better storytellers about all of the ways in which
public health is working to protect people's health every single day.
( 12:42 ):
I was mentioning the malaria that we heard was in the United States last year. It's not here this year,
and that is public health working. That is public health doing its work to do the insect control and the
monitoring and making sure we have tests and treatments. So those are all places where public health
and CDC are working for communities every single day. And because it's working, it's often not seen, it's
invisible. So we also have to be better storytellers about the work that we are doing each and every day.
I'm really proud of what I see.

Mark Masselli ( 13:15 ):
Well, just talk-

Margaret Flinter ( 13:15 ):
I want to see that headline

Mark Masselli ( 13:15 ):
... a little bit about public health during and after the pandemic. We heard all kinds of predictions that
public health funding would be increased, yet the Trust for America's Health reports that state and local
departments are still facing an annual shortfall of close to $5 billion that they need to provide
comprehensive services. I know you're a great champion not only at the CDC, but for public health
departments across the country. How are you and your colleagues making the case to fund public
health?

Dr. Mandy Cohen ( 13:44 ):
Well, one, you have to deliver. It's making sure folks understand the value of public health and show
that we are delivering every day, but that it takes investment and resources to make that work possible.
And remember, CDC dollars, 80% of the dollars that come to CDC go right back out to our state and
localities. But then we need additional investments coming from the states and localities themselves. So
I think it's both working at the federal level and at the state and local level to make sure that the
resources are there. I certainly spend a lot of time on Capitol Hill making sure folks know the work that
we're doing, that we have learned important lessons, that we are a different agency, that we are ready
to respond, but we need the ongoing resources to make that possible. And I am heartened when I see a
proposed Senate Budget that does increase funding to CDC going forward. That's not the law of the land
yet, but I hope to continue to work with Congress to make sure that we have the resources we need to
protect this country.

Margaret Flinter ( 14:44 ):
Dr. Cohen, thank you so much for your time. Please visit with us again in the future and best of luck as
you go forward through these days.

Dr. Mandy Cohen ( 14:51 ):
Thank you so much. Stay well everyone.

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Margaret Flinter ( 14:53 ):
Joining us now to continue our focus on public health is Dr. Georges Benjamin, the Executive Director of
the American Public Health Association. Dr. Benjamin has been in this role for over two decades and
most notably during the COVID pandemic.

Mark Masselli ( 15:07 ):
Dr. Benjamin, thanks again for sharing your thoughts as a guest on Conversations on Health Care.

Dr. Georges Benjamin ( 15:13 ):
Thanks for having me.

Mark Masselli ( 15:14 ):
We just heard from CDC Director Dr. Mandy Cohen on a number of issues. We want to begin by asking
you about the public health challenges right now in the Southeast following Hurricane Helene. What are
you hearing?

Dr. Georges Benjamin ( 15:29 ):
The real challenges, of course, are making sure that people are safe and have shelter, getting access to
portable water, safe food to eat. I mean, those are the two biggest issues. But when you have these
kinds of hurricanes that go through communities and devastate them as seriously as they had here, you
value air safe to breathe, food safe to eat, water safe to drink, and a place to bed down where you're
not going to be injured. It's amazing how you undervalue those things until something like this happens.

Margaret Flinter ( 16:09 ):
Well, thank you for that. And of course, our thoughts and prayers are with people and we know there's
also the trauma impact that people will be dealing with for a long time to come and wish the best for all
the healers there as well. Dr. Benjamin, we just marked Climate Week at the end of September. This was
the first year that the week included a focus on the health impact of climate change. Now we have a
devastating hurricane, kind of brings it all home about this connection between climate and health
becoming stronger to the public. What are you seeing within the Public Health Association and across
the country about really taking note of this connection?

Dr. Georges Benjamin ( 16:45 ):
Well, the debate is over. I mean, anyone who thinks that we don't have climate change and that it's
impacting our health today and our environment has got their head deep in the sand. It's clearly here
today. I think we have to obviously work with adaptation, but it's time to do something meaningful to
reduce the long-term impacts of climate change. We had heat all summer and it's still warm in many
parts of the country. Now we're having these severe storms that are being generated by unusually warm
water conditions. And by the way, hurricane season is not over. We still have at least two systems that
hopefully they won't develop, but look like they might be in the Gulf area today.

Mark Masselli ( 17:36 ):
Well, Hurricane Helene was enough, I think, but it won't stop coming at us and we need to keep focused
on it. Though we want to move on and talk a little bit about COVID. I think most Americans hoped it was
in their rear view mirror, but it's not. And we note that APHA has a messaging that the emergency is

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over, but COVID is not gone. I'm wondering where you're seeing examples of the most effective ways to
encourage vaccinations at this time. I think the early data that we heard was about 2.8% of the people
have gotten the COVID vaccine booster. What are you seeing is the best intervention strategy to
encourage more people to visit with their primary care provider and to take heed of the impact, the
lethality that COVID presents?

Dr. Georges Benjamin ( 18:37 ):
We're telling people to normalize the COVID vaccine as part of their usual preparation for cold and flu
season. So we have cold and flu season that hits us every fall, with the common cold, with influenza,
with RSV for our older citizens. And now we have COVID to add to that. And so we're encouraging
people to get their flu shot, to make sure if you're over age 65, to get an RSV shot, to get updated with
the new COVID vaccine, which is prepared for the new strains that are circulating. Reminding people
that yes, we did have a summer surge, but it seems to be on the downswing. But COVID appears to be in
many ways bimodal. So we should anticipate having another ramp up of COVID sometime later this
winter. So now's the time to get their COVID shot. And what we're telling people is the shot is safe and
effective and will protect you from the new strains and to strongly encourage people to make that part
of their routine respiratory tract prevention efforts.

Margaret Flinter ( 19:48 ):
Well, that message is so important about vaccine. I think we're all working at the local levels to do that.
But Dr. Benjamin, I recently saw a report for those who do get COVID, that there's actually very little
understanding among the public about the availability of Paxlovid or the benefit of Paxlovid for people if
they do get infected. Are you doing any messaging and public health education about this.

Dr. Georges Benjamin ( 20:13 ):
Absolutely. I mean, we're letting people know that prevention is best. But if you do get COVID, to know
those signs and symptoms, to get tested. And as you know, the federal government is now reactivating
the free testing program so you can get free tests. And know what your disease status is. And then once
you know your positive, call your healthcare provider right away and they will go through a series of
conversations with you to ask whether or not you're eligible and should take Paxlovid. Particularly
people with chronic diseases, older individuals should take Paxlovid. It will shorten their disease course
and reduce their risk of really seriously getting long COVID.

Mark Masselli ( 20:59 ):
You stated, Dr. Benjamin, at one point during the pandemic that we, "Must focus in on renewing and
rebuilding our long undervalued public health infrastructure." And I think we see health departments
have been operating for decades really under persistent and widening resource gaps. I think I saw a
figure the other day, maybe about a $5 billion deficit. So I want to ask you, why are we still seeing so
many budget challenges for public health? After we came out of a fairly successful transformation of
public health's understanding by the public during the COVID period, it seems to have waned right now
in terms of people's understanding of the value that public health can play.

Dr. Georges Benjamin ( 21:47 ):
Yeah. As a species, we still don't value prevention. We underestimate risk. We don't think of this as
something that is an investment. So at the American Public Health Association, we have an effort called
Speak for Health where we're working to try to raise the visibility of public health, to make sure people

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understand as Best Buy, that when you spend a dollar on public health, it's a well-spent dollar for
prevention. And if there's nothing that will teach us this message other than COVID, think about all the
other things that we do every day in our lives where nothing happens because we did something that
prevented it from happening. And trying to tell people that something saved them from something
happening when it didn't happen is a tough message to give, but we need to give that message each and
every day.

Margaret Flinter ( 22:45 ):
Well, Dr. Benjamin, you certainly have an extraordinary pulpit from which to get the message out, and
one of those is testifying before Congress about how the country can prepare for what we think are the
inevitable future mass disease events. Maybe give us an overview of your thoughts about where you
think the government has maybe made progress on this. Not just dealing with COVID as we work
through these years, but preparing for the next one. And where are we just not moving forward as
quickly or as effectively as you think we should be to prepare?

Dr. Georges Benjamin ( 23:19 ):
We have learned some things, although I try to be critical when we need to. We've enhanced our
surveillance systems. We now have a much more robust surveillance system that the CDC does. We do
better forecasting at the national level. Just like we forecast bad weather, we have a better job of
forecasting emerging diseases. We have enhanced our ability to deliver vaccine. We have more
vaccinators, more places for people to get vaccinated. The challenge we have now is keeping it up.
Because one of the things is that we build these systems and then we let them degrade very quickly
after the event is over. We have to make sure that doesn't happen again. And it's already happening to
some degree, so we just have to continue to raise the alarm and push our elected officials to do this.
This is an election season and so during election season, it's an opportunity for us to get in front of
legislators to give them our views on how best to protect the health of the public.

Mark Masselli ( 24:17 ):
Dr. Benjamin, you have your annual meeting coming up in Minneapolis of APHA. A couple questions.
One, tell us a little bit about the size and reach of APHA. And then what do you expect to be the big
insights and outcomes from the discussions you're having at the annual meeting?

Dr. Georges Benjamin ( 24:40 ):
Well, this meeting is being Minneapolis, Minnesota. It's the last week in October. The theme is around
trust in public health. We're looking to do a better job of educating our members about how to
reinvigorate trust in public health and to help the public understand what public health is and to really
elicit their support as part of that process. So we'll be sharing some of the best science. We'll have, as I
tell folks, 13,000 of my closest friends that will be in Minneapolis for this meeting. And we'll be there for
almost a week, sharing the best science, networking on ideas, and working with officials both locally and
nationally to try to engage them in the process of improving the public's health so that after the
election, which is actually a week after our meeting, we can then interact with the incoming
administration on ways in which we can ensure that every community in this country has the
protections that it needs to improve its health.

Mark Masselli ( 25:50 ):

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I'm wondering if you could talk a little bit about the impact that we're seeing that private equity is
having in healthcare systems around the United States, really impacting some of these rural hospitals
and hospitals around the country. What are your members saying about it? What's the APHA's view of
this blooming crisis that we're having?

Dr. Georges Benjamin ( 26:16 ):
Yeah. Private equity is a challenge because people want that capital. They want that infusion of cash into
the system. The problem is that venture capitalists are there to make money. They're not necessarily
there for the mission of the organization. And so we're seeing in many places around the country where
we have private equity that's coming in, they invest in systems, they maximize their profit. That often
means closing services down, reducing access to care. And in many of our rural communities, when
these private equity systems collapse, on occasion they do, then those communities are lost. They're left
without the services that they need. So we need to step back as a health system, as a regulatory body at
government, and we need to figure out how best to ensure that every community has the access to care
they need. We have far too many systems that we think we have in place.
( 27:13 ):
So we have many parts of this country, by the way, where there's not access to reproductive healthcare.
I'm not talking about abortion. I'm also talking about just having an OB-GYN to deliver a baby in that
community. Far too many communities don't even have an OB-GYN. We have far too many communities
that don't have access to basic primary care. And so we're going to have to, over the next few years,
really step back and figure out how we properly finance our healthcare system, how we build upon the
system that we already have, so we have a system with everyone in and nobody out, and just having an
insurance card does not guarantee you access to care if there's no hospital or health facility in your
community.

Margaret Flinter ( 28:01 ):
Well, thank you Dr. Benjamin for joining us. And just a reminder to everyone, please subscribe to our
videos on YouTube, find us on Facebook and X with our account named CHC Radio. And as always, you
can go online to chcradio.com to sign up for email updates. And please share your thoughts and your
comments about this program with Dr. Benjamin. Dr. Benjamin, thank you so much for joining us and for
your comments today.

Dr. Georges Benjamin ( 28:24 ):
Thank you.

Margaret Flinter ( 28:29 ):
This copyrighted program is produced by Conversations on Health Care and cannot be reproduced or
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Center, Inc. The views expressed by guests are their own and they do not necessarily reflect the opinion
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