Camp Kotok 2021 – COVID Panel Discussion Video & Transcript

At the first session of Camp Kotok held during August of 2021, we had a COVID (COVID-19) Panel Discussion that included how the Delta variant differs from the original Alpha strain of COVID-19, how it binds to cells and replicates itself, what we know, what we may never know, and how the CDC Foundation is filling a critical function of public-private partnerships and philanthropy to improve the state of our public health system. Find us on social and share your thoughts about #CampKotok with this hashtag.

Speakers:

  • Pierce Nelson (PN)
  • Andy Racine, MD, Ph.D. (AR)

Moderator:

  • Michael Drury (MD)

 

 

MD: [Andy’s] got a very cool background. He has degrees in both medicine and economics, great combination from NYU. Then he taught at Columbia, and most importantly, he married the chairman of the Global Interdependence Center, which is very cool. Second—

 

Audience member: Chairwoman!

 

MD: Chairwoman, chair! The chair! And following him will be Pierce Nelson. Pierce also has a very cool background, in that he went to Georgia State, I went to Georgia Tech, and neither of us went to that other Georgia school that we don’t talk about. And then he was at Wharton, which Global Interdependence Center is based in Philadelphia, so we like that. He also was at Columbia, so they have that in common, and he is the senior Vice President of Communications at the CDC foundation. So I’m going to let Andy go first and then Pierce will follow, and then we’ll, not really questions, discussions, debate stuff.

 

AR: You have two handouts. One of them, move it to the side, it’s an article from the channel that’s about long COVID, we’ll talk about that in a second. First handout was gonna be slides, but since you don’t have slides, you can follow along with the handout. What I wanted to do was talk about a couple of things tonight, one is the Delta variant because it’s on some people’s minds, and then we can spend a little time talking about vaccines, boosters, that kind of thing. But long COVID is something for, I think tomorrow night that David had prepared, and I just sent out this article that you guys can have a look at tonight and we can talk about it. The thing about the article is that it tells us not so much what we know about long COVID, it tells us what we don’t know about it and what we probably can’t know about it, and that has to do with some of the methodology, we can get into that. So, you can put aside your economics ideas, tonight is a science lesson. This is biology, and it’s really just about, if we’re gonna understand what the Delta variant is, we’ve got to understand a little bit about this virus, and that’s really what it’s about. So that first slide, the first piece of paper is just a picture of the virus. It’s what you’ve seen in a gazillion different publications. It’s just this round thing that’s got a membrane on it that’s made out of lipids and it’s got these little red things sticking out of it, and those are those things that you’ve heard of called spike proteins. The curious thing about this thing is that it’s not quite a living thing. A virus is not alive the way we’re alive, in the sense that what distinguishes everybody in this room from the chair that you’re sitting on is that you can take energy from your environment and you can use that energy to make high energy phosphate bonds, and you can use those to do all kinds of neat metabolic things, including reproducing yourselves. This virus has no ability to do any of that: can’t make high energy phosphate bonds, can’t produce. All it is, is a membrane and a set of instructions. And it’s inert, in the sense that by itself it can’t do anything. The only way this virus can do anything is by getting inside a living cell and taking over the mechanisms of that cell to do the things that it needs to do in order to reproduce, because it can’t do it by itself. All it is, is a set of instructions. Now, on the outside of that virus are the spiked proteins, and you’ve heard a lot about those. And if you turn to the next slide, it’s a blown up picture of one of those spiked proteins. And what you can see in the structure of that, is this is a very large protein, it’s made up of 1200 and some amino acids. Amino acids are just the building blocks of a protein. It’s got two different sub-units in it: that top part has a part at the very top called the receptor binding domain. That’s the part of this spiked protein whose job it is to attach to our lung cells or other cells in the body. You can also see that there are other parts of this thing like the stalk on the bottom, the hip, the knee, that allows this thing, when it’s embedded into the surface of the virus, to move around. It flops around, and the reason that’s important is when it gets to see a cell, it’s looking for those receptors. And if it were rigid, and it attacked that cell, it could only get to the receptor that’s right in front of it. Because it can flop around, these spiked proteins can find other receptors in your neighborhood. That receptor binding domain is responsible for attaching to a receptor on our cells, and that’s what the structure of this is about. Now you’re also going to see on that structure a bunch of these brown things that are called glycans. That hides this protein from our immune system. The more glycans that are on it, the harder it is for our immune system to see it. So there are times when this spiked protein will create mutations that will attract glycans to it, making it harder for us to see it. In addition to that, there are all other areas of this spiked protein that can chance with mutations. Substitution of one amino acid for another amino acid doesn’t change the whole spiked protein, but it changes it just enough to make it a little bit more effective at what it does, and that’s what we’re going to get into when we get to this Delta variant.

 

AR: So the next slide essentially blows up what happens when that spiked protein sits on the surface of one of our cells. On the left hand panel, you’ve got those spike protein receptor binding domains in blue that attach to those purple receptors on our cells. The thing on the bottom is a cell in our body, and on the top is the virus. Now, cleverly, the virus is designed to take advantage of everything that our cells can do. One of the things that our cells can do, is that it has on the surface of it, an enzyme. That enzyme is called TMPRSS2, and what that enzyme will do is it will actually cleave part of that receptor binding domain. It’s not a viral enzyme, it’s sitting on our cells, but the virus knows it’s there. And when it cleaves part of the receptor binding domain, it opens it up and it allows these amino acids on the right hand side to connect directly to the membrane of the cell, open it up, and inject the virus into the cell. That’s how that works: it’s not simply attaching to this receptor, it’s that there is an enzyme in our living cells that facilitates entry of the virus into the cell. The next slide then tells you what happens. So this slide is interesting because it tells you the whole life cycle of the virus. You’ve got a virus attaching to the surface of the cell—this isn’t drawn to scale, the viruses are really tiny relative to the cell—and you’ve got that TMPRSS2 enzyme that cuts the spike protein receptor binding domain and allows the thing to be injected. Now this virus is inside your cell, and the first thing that it does is it takes over the mechanisms that the cell uses to read DNA, only in this case it’s the RNA of the virus, and it reads the cell’s own mechanisms and starts producing the proteins that are in those instructions. And the first thing that those proteins are, are instructions to shut off the normal functioning of the cell and use the mechanisms of the cell only to make viral protein. So the cell normally takes all kinds of messages out of its nucleus and sends it into the rest of the cell to make proteins, that’s how the cell sort of keeps doing what it’s supposed to do. The first proteins that are encoded by this virus’ job is to shut that off and then commandeer all of those mechanisms only to make more virus, and that’s what it does. And that makes more virus, more virus, and it gets to the point where the viruses are ready now, they’re all completely made, a new membrane is formed, they’re ready to go out into the world. Before they do that, right as they’re being extruded from the cell, there’s another normal enzyme in our cell called furin, and that spiked protein has on it an area called a furin cleavage site. The more of that site that is cleaved by that furin protein, the more effective the virus is at infecting the next cell. And one of the things that the Delta variant does very well, is it has a mutation on its furin cleavage site that make furin that much more effective at cutting in that area on the spiked protein. What that means is that for every Delta variant virus that comes out of the cell, it’s that much more effective at getting into another cell. And that’s why, when you look at the clinical data about the Delta variant, and you look at the number of furins in a person who’s infected by the Delta variant compared to one of these other variants, it’s an order of magnitude more. A thousand times as many virus particles are found in someone who’s got a Delta infection compared to someone who has an alpha infection, and the reason for that is that the Delta variant has, as one of its mutations, a mutation in the furin cleavage site that makes furin that much more effective. It cuts that many more of their spike proteins and makes it that much more able to infect the next cell in the body.

 

AR: If you look at that last slide, the Delta variant mutations of interest, this is one of these slides that biologists use all the time. What it has on the top essentially are the areas of the RNA message in the virus and different parts of the RNA message in code for different parts of the virus. So for example, that area that says blue from sort of number about 310 to 550, all those amino acids in there, they’re just responsible for making the receptor bonding domain part of the spiked protein. That’s what they’re there for. Things to the left of that make other parts of the spiked protein, things to the right of it make other parts of the virus. On the bottom, it shows you all the different mutations that the Delta variant has relative to the other variants. And you’ll see under the receptor binding domain area, there is a K417N, an L452R, a T478k. those are all separate distinct mutations in that area of the spiked protein that the Delta variant has developed, and some of them make them more easily attached to the ace receptor, some of them make it harder for our antibodies to find it, but that’s what that’s about. And in other areas, you can see near the Furin Cleavage Site that D614G and the P681R, those are two mutations in the Furin Cleavage set which makes the Delta variant that much more effective at infecting other sells.

 

AR: So we’re left with a part of this new virus that’s a little bit better at doing its job than the previous versions of it. And the more viruses that we have out, and the more people, the more likely it is to develop these kinds of mutations that make these things a little bit more effective. The good news is that they can only do certain kinds of things in terms of mutations. Why is that? For two reasons: one, the receptor that it attaches to this ace receptor has a certain conformation to it, a certain shape. If the virus develops mutations that change the shape of its receptor binding domain too much, like a key, it will no longer fit into the lock. And so those mutations don’t do the virus any good because it doesn’t make it any easier to get into the cell. If you can’t get into the cell, you can’t reproduce. The repertoire that the virus has available to it is constrained by the structure that it has to deal with on our cells. And the second thing is that we are all, all of us who have either been infected or vaccinated, are producing antibodies that attach to various portions of these spiked proteins. And the spiked protein mutations now have to deal with that pressure also. So on the one hand they’re being constrained by the structure, on the other hand they’re being constrained by the pressure of natural infection and vaccines throughout the population. And the more that they’re constrained, the less they’re able to actually mutate, which is why it’s important for more people to be vaccinated. The more people you have vaccinated, the more antibodies we have floating around, the harder and harder it is to get more dangerous mutations over time.

 

AR: So that’s the lesson for the Delta variant. I’m going to shift that for a moment about long COVID unless people have questions about this, I’m glad to answer.

 

Audience member: How does this virus enter the body?

 

AR: So the virus enter the body the way most respiratory viruses enter the body through various mucus membranes. It can either happen directly, somebody coughs on you, gets it in your eye, your nose, your mouth, or you can get it on your hands and you can rub your eye or your nose and introduce it that way. Those are the two ways, you can’t get it through sex as far as we know, you can’t get it through eating it. You can’t get it through other ways that people get other kinds of viruses. This is a respiratory virus and has to go through those mucus membranes.

 

Audience member: So we’ve been hearing about breakthrough infections from COVID, but we haven’t really been getting numbers relative to how many people are vaccinated. If we’re 175-180 million vaccinated individuals, what is the percentage of breakthroughs that are getting through?

 

AR: That is a great question. Here’s the problem with that. A lot of people who get breakthrough infections are asymptomatic. Or they have a runny nose for a couple of days, they never get tested. We do know, of the people who have had breakthrough infections who’ve been hospitalized, there’s only about 5000 of them so far, there are a few people who’ve actually gone to an ICU and even died, but those are mostly people who have underlying conditions. So it is possible certainly to get breakthrough infections. The vaccine in clinical trials was 94% effective, and that’s for people who’ve had two vaccines. And that was in specific clinical trials before there was an alpha variant in the UK, before there was a 351 variant in South Africa, before there was this variant. It’s a very effective vaccine, in fact, it’s an amazing thing what’s happened here. It’s unprecedented in terms of the science, what we’ve learned and how we’ve done this in such a short amount of time. And these mRNA vaccines are brand new technology, fabulous. But yes, it’s true that you can get breakthrough infections. The other thing that’s not clear is how effective people who have been infected after being vaccinated are at transmitting it to somebody else. Now there was this whole big article about this thing that took place up in Provincetown, Massachusetts where a whole bunch of people—75% of them—were vaccinated and they all got it. And this is the other thing, you have to be very careful when you read things like The New York Times or the Wall Street Journal because they’ll say, “it looks like it’s as easily transmitted by people who’ve been vaccinated as other people,” and we don’t know that. And the way they’re making that inference is they look at the amount of viruses in people’s noses and they say there’s a lot of virus in people’s noses. Well there’s two things about that: the test that you use to test for whether there’s virus in your nose doesn’t tell you whether that’s viable virus. It’s a test for the genetic material from the virus, the PCR. So there’s a lot of viral stuff in your nose, but the chances are that in order to actually give it to somebody else, you have to have it in your lower respiratory tract. You have to have it in your lungs and be able to cough it out. Walking around with the stuff in your nose may not be enough to give it to somebody else that you’re kissing or something. So we don’t really know how transmissible people who’ve been vaccinated are, but chances are they’re very low.

 

AR: So the last thing, and then I’ll turn it over to Pierce. The article about long COVID, this is another big methodologic conundrum. What is long COVID? Well, we don’t know, right? The definition is anyone who’s had some symptoms relative to COVID longer than 30 days after they were discharged from a hospital or 6 days after they were first diagnosed. It could be a cough, it could be malaise, it could be people feeling tired, having shortness of breath, upset stomach, diarrhea, memory issues, there’s a huge list of things that it could be.

 

PN: Well thanks Andy. One of the caveats I was going to give tonight is that I’m not an epidemiologist, and so it’s great having you here being able to talk this through in such detail and so thank you for that. And David, thank you for having me this year. I got to know David when I worked for the Federal Reserve Bank of Atlanta. I was there for 15 years and I got to know David then, and he started telling me about Camp Kotok, and it’s great to be here with Bob as well. Bob was my boss at the Federal Reserve and it’s good to be here with him. My current boss actually was here a few years ago as well, her name is Dr. Judy Monroe and she was here at the time talking about Zika and the work that CDC and CDC foundation, where I work, were doing together in U.S. territories, working to battle Zika there and working with the people there. So this evening I want to talk a little bit about the work that we’ve been doing at the CDC foundation, so I’ll give you a little bit of background on the CDC foundation, who we are and what we do. I’ll talk about this interesting development that happens during emergency responses as far as how funding is available. Then I’ll talk a little bit about some of the work we’ve been doing in this response, and then I’ll close with a few words about public health and our public health system and the future of public health as well.

 

PN: So the CDC foundation was created by Congress back in the 1990s, and we were created as a way to extend CDC’s lifesaving work, and we do that through public-private partnerships. And when I talk about public health here I’m talking about the health of the population and all of us, whereas healthcare is focused on care for the individual. The CDC foundation was based on the experiences of some previous CDC directors and, just show of hands here, has anyone heard of Bill Foege? Bill Foege is a former CDC director, and Dr. Foege actually came up with the strategy to eradicate smallpox, which is the only disease that’s ever been eradicated. But based on his experience and some of the experiences of other CDC directors, they knew that government has really a lot of strengths. They also have challenges. And the same is true of the philanthropic and private sectors as well. But when we bring those groups together, we actually can take on some of the big health threats that society faces. And so the CDC foundation in normal times, we work with CDC on a variety of different types of issues. When I say “work with CDC,” we work with CDC and partners and we bring donor funding to that. And we’ve addressed chronic conditions like tobacco usage and the ill effects caused by tobacco. We’ve worked on issues around infectious diseases like meningitis and the meningitis belt in Africa and HIV as well. And then we’ve worked on emergency response-related work with them quite a bit over the last several years. If you think about Zika, Ebola, and now COVID-19 as well. So, since our creation about 26 years ago, the CDC foundation has worked with CDC on about 1200 programs, we’ve raised about 1.6 billion dollars through the work that we’ve done, and we’ve done that work in countries across the world and particularly here in America as well. So, for COVID-19, we all know that for a long time people have been talking about how there could be some sort of infection that would start somewhere in the world, would travel here and to other countries and spread rapidly. And so our team at the CDC foundation back in early 2020, we started seeing what was happening and we became concerned, and we actually were I think the first non-profit that launched a response for COVID-19 on January 27th, 2020. And really what we’re striving to do is to bring private sector resources together with the government resources to meet some of those in the moment type of needs that arise where government funding may not be available quickly enough or may not be able to meet the actual need because the money is not being able to be spent for whatever that need may be. Another point I want to make here is, while the work we do with the private sector is extremely important, government funding is absolutely essential when we’re dealing with something like COVID-19. And that is an essential element that must be a part of the response. So I want to shift and talk a little bit about the work that we’ve been doing with donors and in addition to working with corporations as well as working with the government, we also work with individuals. And so for the COVID-19 response, we’ve had several hundred thousand people who have donated money to the CDC foundation for our response to COVID. And we’ve also worked with corporations an philanthropies as well. Some of the organizations we’ve worked with include Morgan Stanley, Anthem, United Health Group, and the list goes on. I’d like to talk just a moment about our work in action just to give you some kind of examples of some of the work that we’ve been doing with CDC and with public health.

 

PN: So, early on in the response you may remember there were a lot of immediate needs that were rising up. Personal protective equipment was really an important one. And so the CDC foundation, through the work that we were doing with partners, we were able to source and then share across the country with frontline responders and other groups eight million pieces of personal protective equipment. That was one of the first things that we were really focused on at that time because of the shortage, but then we started to pivot to other types of work as well. We’ve sponsored quite a few studies looking at a variety of different COVID-related issues, including a study that we’ve done looking at COVID in pregnant women. We were one of the first funders to that and additional funders have stepped in, and that’s really a great thing when we’re able to provide some support through the generosity of our donors that then can bring in other funders to kind of get the ball rolling on something like that. Another thing that I’ll mention is public health departments. It’s been a challenging time for public health departments throughout the country, and so the CDC foundation, some of the work that we’ve done is working directly with public health departments, bringing together both public and private sector support to hire some of those folks who are needed to meet the needs on the ground. So this includes everyone from epidemiologists to lab technicians, to communicators, just depending on whatever the need may be. We’ve hired about 1000 people that we’ve placed throughout the country, and we’re in the process of hiring another 2000 to help bolster public health departments both for the COVID response but also for longer term as well to help support the public health system.

 

PN: And that’s based on a variety of different factors. One is communities of color, for instance, not being able to have access to the healthcare that they may need or having pre-existing conditions or also maybe working more in frontline types of jobs that put them at greater risk for COVID. So we’ve worked on quite a few health equity related projects, about 130 or so projects that we’ve worked on around the country focused on various issues that would be helpful. And then the last thing I’ll mention is we do quite a bit of global work as well. We’ve done in the moment type work on COVID, and a recent example of that is India. You all probably read about the rising cases that they had back in April and May, some of the really dire situations they were having there. We worked with CDC as well as with folks on the ground in the country, and we shipped over 170 of the really large oxygen containers that we were able to get in very quickly to help address some of the needs there.

 

PN: So I’ll close out by talking a little bit about the public health system and the future of the public health system. As I said earlier, it’s been a challenging time for public health at the federal state and local levels overall, and there really has been sort of a convergence of a number of different factors that have come into play here. There’s been this rapidly evolving pandemic, the worst in 100 years. There has been a really polarized political environment that’s created quite a few challenges as well, and then another challenge has been just the funding situation for public health departments for quite some time. Earlier this year, the Trust for America’s Health put this situation in context, and I’m just going to read what they had to say: “under resourced, understaffed, and overburdened health agencies responded to a major pandemic with inadequate systems, and the country’s long-standing failure to invest in disease prevention, address the root causes of poor health, and promote health equity made the nation less resilient.” Their report goes on to talk a little bit about the funding situation in public health departments. The country spends each year about 3.8 trillion dollars, in 2019 it spent about 3.8 trillion dollars, and on health care about 2.6% of that actually went toward public health and prevention, the smallest share since the year 2000. So another challenge that the health departments have been through as well is that their employment is also down. So even before the pandemic, again, according to the Trust for America’s Health, about 10% of the full-time equivalent workforce in public health was down from 2012 to 2019, and then at the local health department level, it was down about 16% from 2008 to 2019. Many organizations are looking at the future of public health and how to try to strengthen it going forward, and the CDC foundation is working with a number of different partners, including the Bipartisan Policy Center, to look at how we can strengthen public health going forward. Everything from looking at staffing issues and trying to help there as well as training and then in addition to that, looking at how to improve technology use throughout the public health workforce, which is something that is very much needed as well. I’ll close with this, and it goes back to something that I said earlier, is when we all work together, the private sector, the public sector, when all of us come together, we really have what’s needed to meet the challenges that face us when it comes to health and public health going forward. So I’m hopeful that we’ll all be able to work together and make sure that we’re putting in place the prevention efforts that we need to make sure that something like doesn’t happen again.

 

Audience member: When you say you want to prevent something like this from happening again, when you say “this,” I mean we can’t prevent, I don’t think, viruses from developing in the world, so what is the “this”? Is the “this” sort of our vigilance, like we would heighten our vigilance so when we have that patient zero in Washington state we just become hypervigilant? Because we now realize that person wasn’t patient zero, that there were other patients earlier at the end of 2019. But what is the “this,” I guess is my question, that we can prevent?

 

PN: Sure, there are a couple pieces to that. One is, we can work with other countries to help them prepare their systems so they’re able to identify issues sooner. So it’s important to have that partnership where other countries are working, including the United States, will be working with those countries to help them prepare to respond and then hopefully catch things earlier. Then here in the United States, we also need to continue to improve our systems here as well. We may not be able to prevent these viruses form starting in the first place, but hopefully we can stop them before they cause the damage that they have.

 

Audience member: So I have a question for both of you, and that is, preparing for the next either cycle of the current virus or the next pandemic, could you, Pierce, tell us what the foundation could put in place very specifically, and Andy could you please tell us what health system has to be put in place?

 

PN: I don’t think any one organization is going to be able to put into place what’s needed for this. It’s going to be a combination of the government at the national level working with the states, working with the public health authorities, working with the private sector, bringing all these groups together to address this situation and really have the will to move us forward. I think businesses have seen just how difficult and damaging this has been as well, and I think they can be a powerful voice moving forward to work with these other groups I’ve mentioned to try and make a difference. So that would be my response, and I mentioned one of the examples in my remarks about the work that we’re doing with the bipartisan policy center, that’s just one example. Some other things that we’re trying to do, working on staffing issues and the state and local health departments, trying to work with them to bring more staff to those departments and then also on other issues related to training and things like that.

 

AR: There are a couple of things that we know didn’t go well this time around. At the beginning of an epidemic, you have an opportunity through testing, contract tracing, isolation, and quarantine, to create rings around those initial cases. That first case, for example, that we saw in Washington state, that virus was already circulating for weeks in that area of the country. But testing, contract tracing, isolation, and quarantine are the basic foundational elements of epidemiologic approach to epidemics. We blew it this time around on that. We didn’t have a test that was available, we didn’t have the ability to do this kind of contact tracing for many of that reasons that Pierce mentioned. Contact tracing is done by public health facilities and there weren’t people around to do that, so that’s part of it. In terms of health systems, having seen it firsthand, we play the same movie over and over again. This happened in the Ebola crisis. What happens in Ebola is that you’ve got this virus out there that people are concerned about, and then every separate healthcare system is on its own to figure out what to do about it. What happens is you get some guy in Albany, New York telling you, “you’ve got to do this and this and figure it out.” The same was true this time around. We didn’t learn from the Ebola crisis. Everybody had to set up an Ebola unit. So in two weeks we spent several million dollars to create a unit that could take care of two patients with complete isolation, and a lab that was separate. This time around, what happened, no one had adequate amount of PPE, no one could test patients who were coming into their facility. No one could coordinate if you needed staff. The first patient that came to Montefiore hospital was on March 10th. Two weeks later, we had 2000 patients in our systems. Two weeks later, 150 patients a day had to be admitted to the hospital. You have to find new beds for 150 patients every day. You just don’t have the facility in a single institution, you have to coordinate that. There was no coordination. Why? At the federal level they’re saying, “every state you’re on your own.” At the state level they’re saying, “every health system you’re on your own.” That’s no way to run a response that’s all over the place. Those are the things we have to plan for to figure out.

 

Audience member: Well I would say we haven’t even learned so far with the way the Delta variant is raging in certain parts of the country, and they aren’t doing it better this time.

 

Audience member: Is there a need to think about changing the approval process and testing process, the monitoring process to determine the effectiveness of various treatments? It seems to me one of the things that was very important was the speed with which the virus was ultimately able to be treated with various vaccines that were developed. But then there’s the issue of people who are very hesitant because, “hey it’s only an emergency approval, it’s not really an approval.” That really cut back on a negative in terms of public acceptance of the vaccine. Do we need to rethink some of that process?

 

AR: Well you could do the thought experiment and say “What if the FDA had given full approval?” Where would we be in terms of our vaccination levels? I’m not sure that we would be that much further along. I haven’t spent a lot of time talking to people about it. You ask them, “what are your concerns?” “Well it was developed too quickly,” “I don’t know what’s in it,” “It’s going to affect my fertility,” “I just don’t like to put things into my body that I don’t know what they are.” When you have 16 different reasons for why somebody doesn’t want to do people, there is no reason. It’s fear. People are very anxious and afraid, and the left side of their brain will figure out a rational way to express that, but it’s really all coming from the right side of the brain. They’re afraid. And for certain people that just takes a lot of time to work through. They come to it in their own time, and I know that there are a lot of people who want that to happen more quickly, but that’s not the way people work.

 

PN: I think there are some people who have very legitimate concerns around healthcare and public health just based on their previous experience. You have to bring those people, help them understand why this is important, how it’s been carefully considered, how it’s been developed. Yes it’s been developed quickly, but it’s been built on technologies that were in existence. And it takes a while to do that. But I think more generally as a nation, I think we need to reflect back on just how much we’ve gained here and around the world from vaccines. We need to keep that in front of people going forward. Just like we’re talking about making improvements throughout the systems that underpin what we’re doing. We need to make sure that we keep these messages around vaccinations going forward because it’s critically important that we not step back here. We have to move forward and we have to have people understand the importance of being vaccinated because it is the way that we protect ourselves, it’s the way we protect our families, and everyone.

 

Audience member: So this go-around, there seems to have been a lot of misinformation spread through social media, certain cable channels, etcetera. What can we do as a country to have people be better informed and not reacting to nonsense on Facebook or elsewhere?

 

PN: I think it needs a very concerted effort from the government, from business. One of the things that we’ve worked on that I didn’t mention, we’ve worked with a group that we put together with the business roundtable, the ad council, the Beaumont foundation, and the Robert Wood Johnson foundation, it’s called the Health Action Alliance. And part of the reason that we created that is it’s focused on working with businesses to try to give them information that they can use to educate their employees. You might say, “well what difference does that make?” Well, one of the things that research has shown is that people trust their employers more than they trust, in many instances, the government. So we’ve tried to use businesses to get out trusted information that employers can take and use with their employees. And we’ve also talked with them about other things that they may consider as part of those efforts. For instance, if you have other employees who are able to talk about their experiences with vaccines, that can be useful to people who may be trying to make that decision about whether or not they want to be vaccinated. So I think that’s one example of how we can move forward. But it’s extremely challenging. We have a very fragmented way that people get information now. It’s not that they listen to the five o’clock news and that’s what they’re getting. They’re getting information from everywhere.

 

Audience member: Pierce you made it sound like there was equal opportunity screwing of public health by both Democrats and Republicans from the White House. How do you change that tenor to get increased funding?

 

PN: For the record, I don’t think that’s what I said exactly. What I was trying to convey is, and not in any way put blame on where we are, just stating this is where we are, and we need to collectively move forward in trying to gain the appreciation and ongoing support. I mentioned one of the examples of working with the Bipartisan Policy Center. I think this is a bipartisan issue. Our health is an issue that we should all care about no matter what our political background is, and so this effort is really trying to put forward an approach that would look across the span of different types of topics, and try to help educate and get buy-in and support for building, and rebuilding in some cases, the public health systems.

 

AR: Pierce is not allowed to say this, but I have no such convictions. There is an asymmetry with regard to the political approach to this public health issue that is evident throughout the country. And, my apologies to Bruce in the corner but, there is no question that there’s some real politicization of this. It’s very strange. I have to say, I spent many years as a pediatrician, and I find this baffling also, and I would talk to parents all the time about giving their kids vaccines. I never once had an in-depth discussion with any of my parents about giving their kid a polio vaccine. Two, four, and six months, 12 to 18 months, kids come in and get polio shots. Never had a conversation about it. There hasn’t been a case of polio in the Western Hemisphere in 50 years. It doesn’t exist. But nobody cares about that, it was fine. But when it comes to the flu shot, I spent countless hours talking about the flu shot. Don’t ask me why. The flu kills 35,000 people a year in this country like clockwork. And yet somehow, to convince somebody to give their kid a flu shot is a big deal. Well, COVID is like that, just more so. It’s baffling, but we can all do better in terms of messaging and we can all do better in terms of trying to understand people’s concerns and fears and help people get to the right place in this. Because it’s important, as Pierce said, not just for the people who are vaccinating but for everybody around. And that’s how we’re going to get through it.

 

MD: David, final question.

 

David: For Andy and for Pierce, who is working with public health organizations around the country, and Andy you have a hospital system. Sarasota Memorial Hospital we are now short 400 or 500 nurses. When we open in Venice the new cancer center, 900 nurses. We’ve had to pay up to bring 30 nurses from the Philippines because we don’t have enough. We are losing healthcare professional staff faster than they can be replaced, and my understanding is that is nationwide. You have your institution, I suspect you see that. You talk about staffing and we have millions of healthcare workers, a growing shortage in the United States, and it’s getting worse every day. And we have a political system that doesn’t wanna talk. “I don’t want to do anything about it, I live in Florida.” We have a person dying of COVID every seven minutes, a Florida resident, and we have a state Department of Health which is a sham and a farce, because Bolsonaro is our governor. I’ll go on the record, I’ll do everything I can to destroy his political career. Because he kills people. But he also removes the staff of the entire healthcare system. You mentioned staff. Where do we go for staff? Where do you go for COVID?

 

AR: Well, right that’s a question for everybody else in the room. You guys are economists here right. So you have to attract somebody to do a job that is dangerous, that is unpleasant, hard, and that you’ll need a lot of training for. If you want somebody to do that work, you’ve got to pay them a lot. And we don’t. Clearly there’s a market clearing price for everything, David. We haven’t reached the market clearing price in that labor market.

 

PN: I would say from a public health perspective, I do think the administration is focused on recruiting, bringing forward a new group of public health workers. I think that’s great. I think the challenge that I would just mention more broadly for public health is, we’ve have these cycles where we have a crisis and money comes in, and then it sort of leaves, and then we get to another crisis and money comes in, and then we go back down to the lower levels. So I think from a public health perspective is sustaining that investment going forward. And that’s from prevention, preparedness type of issues, but it’s also from a staffing perspective as well, and a public health workforce perspective.

 



We'd like to thank our panel members and moderator, Pierce Nelson, Andy Racine, MD, Ph.D., and Michael Drury, and also thank you for taking the time to watch and/or read our Camp Kotok 2021 – COVID Panel Discussion. More Camp Kotok related discussions and panels are available at The Global Interdependence Center's website, https://www.interdependence.org/resourcesroom/camp-kotok, and here on our website, https://www.cumber.com/about/camp-kotok.


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