‘It’s a Pandemic, Stupid’

By Lisa Lerer Politics Newsletter Writer

Hi. Welcome to On Politics, your guide to the day in national politics. I’m Lisa Lerer, your host.

As the director of the Centers for Disease Control and Prevention under President Barack Obama, Dr. Tom Frieden led the U.S. response to the swine flu, Ebola and Zika epidemics.

Three years after he left his post came the big one. On Wednesday, the United States hit a new high point for daily coronavirus cases, with infections surging in the South and West.

This time, Dr. Frieden said, the federal government had not been up to the task, turning the country from a perennial health leader to “a global laggard” on the coronavirus.

After leaving government, Dr. Frieden established Resolve to Save Lives, a $225 million five-year initiative to prevent epidemics and cardiovascular disease. Now, he’s urging policymakers, politicians and all Americans to embrace the “messy truths” of a complex pandemic.

“This concept that it’s about health versus economics is really misguided. James Carville said, ‘It’s the economy, stupid.’ Well, it’s a pandemic, stupid,” Dr. Frieden said. “If people don’t feel safe going out, we’re not going to get our economy back.”

We talked to Dr. Frieden about the federal response, state shutdowns and what we can expect this fall. He even indulged us in a lightning round of Covid-19 questions: Yes, you can take the subway. Enrolling children in summer camp? Well, it depends.

(As always, our conversation has been edited and condensed.)

Thanks for talking with us today. Can you grade the federal government’s response, five months since the first known coronavirus case was reported in the United States?

This is still not a time for grading. It’s a time for improving. Certainly “needs improvement” would be a part of that grade.

We’re still in the relatively early phase of a very deadly pandemic. And the way it’s been handled has obscured the messy truths of reality and created false dichotomies. It’s just not about closed versus open. It’s about how to open safer and how to do it carefully so we don’t have to close again.

Another is masks versus no masks. You don’t need a mask if you’re outdoors not near anybody. You don’t need a mask if you’re in a community that doesn’t have Covid. But if you’re in a community with Covid, and you’re within six feet of someone, particularly indoors, if everyone wears a mask, everyone will be safer.

Is Covid overblown or is it this horrible disaster? The fact is, it’s a deadly pandemic. But it also causes a lot of mild illness. I was just thinking back to late March, I had gone from months of saying, “We have to take this really seriously,” and then suddenly there was this kind of, Oh my God, the sky is falling. And I remember writing, This is not a zombie apocalypse, we are not all going to die. Ninety-nine percent of people who get this virus will recover.

And it’s not about health versus the economy. Protecting health is not getting in the way of economic recovery. It is the route to economic recovery.

You have talked about the pandemic in terms of the five stages of grief. Is the country at acceptance yet?

Nowhere near, I’m afraid. We’re still debating. Is it here? Is it gone? What’s going to happen? Is it important? For example, let’s get past the debate of, Is it a real increase of cases or just increased testing in many states? There is no question. It’s a real increase. Anyone who understands epidemiology can glance at the numbers and tell you that.

Reality is often fairly complex. This is a really bad pandemic. It’s very dangerous, and it can cause serious illness or death in anyone, but it is much more severe for older people, people with diabetes and obesity, African-Americans, males. And it’s much more likely to spread in certain settings, like crowded indoor spaces, like church choirs where people are singing.

Part of that acceptance means figuring out how we can restart as soon and safely as possible without rekindling, and clearly, the way Texas, Arizona and other states have done that isn’t the way to do it.

In some of those states, there’s little political will to take steps that will stop an outbreak. Do you think at some point we’ll have to return to the shutdown measures from March?

What we’ve been saying since January is that we need an adaptive response, that we need to be able to tighten or loosen physical distancing based on the actual conditions.

Part of the problem with the U.S. response was that it was too blanket. I can understand why people in areas without much Covid said, “Why in the world are we wasting time because they’ve got a disaster in New York City and a few other places?” And now that the disaster is heading there, they’re tired of staying home, and they really didn’t have to stay home for a while.

What would you do to stop the spread if you were still in government?

Start smarter with the three W’s: wear a mask, wash your hands, watch your distance. And box it in with strengthening public health: be able to test, isolate, contact trace and quarantine.

If your number of cases is increasing and your tests are stable or increasing and the percent positivity is increasing, you have an expanding outbreak — period. But where is it coming from? Are we doing investigations to figure out the settings where it’s spreading? This is really important so that we can be more granular in our control measures.

If you do those things really carefully, yeah, we’re not going to be reopening bars anytime soon. And we’re not going to be having big indoor gatherings with thousands of people. But there’s a lot else that we can do in our economy that isn’t like that.

There’s a lot of confusion around what people should be doing. Can we do a quick round of rapid-fire Covid questioning? Sending your children to summer camp: good idea or bad idea?

That’s an “it depends.” It depends what the spread of Covid is in the area. It depends what kind of safety measures there are at the camp. It depends if your kid has any underlying health conditions that could make them more susceptible to illness. It depends how much of the activity is outdoors versus indoors. It depends how well the facility does at limiting mixing among kids.

We do have to have a discussion about schools because schools are really important for our kids in many, many ways. And the health and economic harms of closing schools are enormous.

What about going to a protest?

Outdoors is much safer than indoors. And outdoors with a mask is safer still. However, anytime you have lots of people getting together from different places, there is a risk of spread. And that means if you’ve had contact with others within six feet, then for the next two weeks you need to be very attentive to the fact that you may be spreading the infection.

Of course, use of things like tear gas, pepper spray — anything that increases coughing or gets people more likely to take their masks off — increases the risk. And, of course, being put in jail. Jails, we know, are a major risk of Covid spread.

Going to one of the president’s indoor rallies?

One thing that will be important is to know what proportion of people are wearing masks and where people are coming from. Now, people make judgments about what risk they want to take. The role of public health isn’t to tell people what risks they should take. It’s to tell people what the risks are so that people can decide for themselves.

What about taking the subway or a bus?

If you have underlying conditions, then you need to hold back longer. If you’re over the age of 60, you need to hold back longer. And the older you are, the higher your risk of severe illness is. It also depends on the community you’re in. In New York City, we’re seeing a really encouraging fall in cases. And if we keep it up, we could get this virus to relatively low levels.

But you’d want everyone there to be wearing a mask. You’d want to increase ventilation. You’d want to be really careful about what you touch. You want to not touch your face, nose, eyes, mouth. You want to go out with a bottle of hand sanitizer. And if you must adjust your mask or touch your face, sanitize your hands before and after. So, not so easy.

OK, one more: Going to the grocery store?

Groceries aren’t a problem. But going to the grocery store, how crowded is it? Are people wearing masks? The issue really is the duration of time indoors, exposed to others without a mask. So if I was going to pop into a nice grocery store in my neighborhood but I saw the aisles full of people not wearing masks, I’m not going there.

I’m going to ask you a question that I suspect you don’t have the answer to, but I’m going to ask it anyhow because everybody wants to know. What’s the fall going to look like?

We don’t know.

Anyone who tells you with confidence what’s going to happen with this virus more than three or four weeks into the future doesn’t know enough about this virus. But there’s no reason to think it’s going to magically or miraculously go away.