On this last episode, we look back on 23 years of joyous, difficult and always informative conversation.
“They were not simply names on a list. They were us.”
Perhaps you saw the obituaries on the front page of the New York Times this past weekend. The brief biographies of 1,000 human lives lost to COVID-19 — just one percent of the now more than 100,000 reported deaths in the United States.
What does this grim milestone say about how we’re responding to the pandemic? What progress has been made toward a vaccine? How are local jurisdictions planning for reopening in the midst of warming temperatures and growing “quarantine fatigue”? And how can we all assess our personal risk, deciding what’s safe to do and what’s not?
In times of uncertainty, we look to medical professionals for guidance. Emergency physician and public health expert Dr. Leana Wen joins us to share her expertise and answer your essential questions.
Produced by Julie Depenbrock
- Dr. Leana Wen Emergency Physician, Visiting Professor, George Washington School of Public Health
KOJO NNAMDIYou're tuned in to The Kojo Nnamdi Show on WAMU 88.5, welcome. Later in the broadcast moral philosophers weigh in on how we can make ethical choices even in the midst of a pandemic. But first, "They were not simply names. They were us." Perhaps you saw that on the front page of the New York Times this past weekend. The brief biographies of 1,000 lives lost to COVID-19, just one percent of the nearly 100,000 reported deaths in the U.S.
KOJO NNAMDIWhat does this grim milestone say about how we've been responding to the pandemic? What progress has been made toward a vaccine? And how are local jurisdictions planning for safe reopenings in the midst of warming temperatures and growing quarantine fatigue? Joining us now is Dr. Leana Wen, an Emergency Physician and Professor of Public Health at George Washington University, formerly served as Baltimore's Health Commissioner. Dr. Wen, thank you for joining us.
DR. LEANA WENHappy to be with you, Kojo.
NNAMDIAs we have said, the U.S. now has recorded close to 100,000 deaths from COVID-19. Is there any end in sight to the pandemic?
WENAt this point we need to recognize that we're going to be living with COVID-19. We as a world, certainly as the U.S., had a chance to contain COVID-19 and stop it in its tracks, but we have not been able to do it for a whole number of reasons. And until we have a vaccine, which is not anywhere near the horizon at the moment, we need to reconcile with the fact that we are going to be living with this. Now, all is not lost. There are things that we can do to reduce our personal risk, to reduce our collective risk. We do have to reopen and get back to as much of normality as we can when it comes to business and the economy. But we are going to be living with this virus, and we will see more infections, more hospitalizations and more deaths.
NNAMDIYou're a Contributing Columnist for The Washington Post. And in your most recent piece you talked about how we can assess our personal risk as we begin to make choices about what's safe to do and what isn't. What are some of the things we need to consider?
WENAny time we interact with those outside of our immediate family. There is going to be risk. Now we need to assume some of that risk, but there are also ways to make our interactions safer. And so think about reducing our risk with three variables proximity, activity and time. So the highest risk is going to be if you're in a crowded indoor area with a lot of other people, because of asymptomatic transmission we know that there could be somebody who doesn't have symptoms, but who could be infecting dozens of others in that small space. That risk is increased if you are singing, if you are talking loudly in a loud space, as an example, and certainly if you're hugging, kissing, sharing drinks and utensils. And also the longer time you're there the longer length of exposure the higher that risk is as well.
WENSo you can reduce that risk conversely if you're going to be seeing friends invite them over to your backyard or to a park where you can each keep at least six foot distance between people of different families. Don't hug, kiss, share utensils. Don't pass around a platter of food that you're all going to be dipping your hand in. And if you're going to go to somewhere like a restaurant, take out is still the safest. If you have to sit somewhere, sit outside physically distanced, and, again, try not to stay in one area for a long time, because that length of exposure is something we can control, so proximity, activity and time.
NNAMDIHere is Mark in Silver Spring, Maryland. Mark, you're on the air. Go ahead, please.
MARKGood afternoon, Dr. Wen. I'd like to make two points regarding wearing masks and social distancing. Few people would push an elderly couple aside if they're moving slowly at Costco. So why not at the same time wear a mask so you don't endanger people, who are more vulnerable than you. Secondly think of the healthcare workers already overburdened and in danger of making their own mistakes too that could hurt themselves. So please be considerate of them as well, and do social distancing and wear a mask.
NNAMDIDr. Wen, care to comment?
WENI cannot agree more with what -- Mark, what you just said. Wearing a mask, keeping that physical distancing, they are signs of respect, because it means that I care about you that's why I'm wearing a mask for you. And just to clarify on where we should wear masks. If you are going outside and walking and there's nobody around you, you don't need to wear a mask. If you're inside your own house with your own family members, you don't need to wear a mask.
WENBut if you're going out to the grocery store, if you're going somewhere where there's a public elevator, if you're going walking and you know that others -- it will be potentially a packed area, you should wear a mask or at least bring one with you and put it on when necessary. That's a sign of respect. It shows that we care about one another and it reduces the rate of transmission of COVID-19 for everyone.
NNAMDIThank you very much for your call, Mark. Here is Dr. Masik, who is right now in upstate Michigan. Dr. Masik, your turn.
DR. MASIKHey, how are you doing? Giving you an update, working on the res' in upstate Michigan, two things. One is that I want to recognize all the various physicians, who are working in clinics rather than hospitals doing this sort of work. And the second thing, it's a very, I guess, American story. On the one hand is a reservation. They get a lot of their revenue from casinos. This is a tourist town. And so we really have to balance the health of the population with opening up the casino and bringing things from out of state. And so, again, it's going to be a real dilemma in terms of how we can balance those two things, one to bring in the tourist dollars to keep this tribe going. Second of all how do we safeguard our native population here?
NNAMDIThank you very much for sharing that with us, Dr. Masik. Leana Wen, it's something that in this region we're also looking at, because most of the region will be beginning to open up this weekend. And as you know, this is a region that is heavily attractive to tourists also, any advice?
WENWe need to have, again, with all these issues, it's a balance. There isn't one right answer. We're never going to be able to say this one action is going to make it 100 percent safe. The only thing that is going to make it 100 percent safe is a total shutdown, which nobody wants and we're not able to do. So everything has risk. But how do you balance this? Well, part of it also involves having the capabilities in place. So having surveillance so that -- and real time data so that if there is going to be an outbreak the sooner we can detect that the better. The better the chance that we have of reigning it in.
WENAnd so we all need to be doing as much as we can to increase testing, contact tracing, the ability to quarantine and isolate. Those capabilities are lacking all throughout the country. And the more that we can bolster those capabilities on a local level, of course, with state and federal assistance, the better that's going to be.
WENWe need real time data, again, so that we are able to also pivot accordingly. If we do need to increase restrictions or implement new quarantining standards we need that real time data to guide us. So that's what we could be bolstering, and in the meantime not be complacent. I think there is misunderstanding now about reopening. I actually think that it's a misnomer, because reopening seems to imply that things are fine. That we can go back to the way that things were before. But nothing about the virus has changed, and in fact, we need to be changing our behavior and quite substantially adjusting our own normal. And keep up that physical distancing.
WENJust because you now can do something doesn't mean that you should. Just because you know can go to work and should go to work doesn't mean that you now also need to be getting your haircut and eating out at a restaurant and scheduling playdates for your kids. Actually it means that if you are going to be going back to work, you should be doing everything you can to cut out those risks in other parts of your life, because there is such a thing as cumulative risk. So reduce the risk in as many parts of your life as possible in order to get the economy back and running.
NNAMDIOn now to Adam in Washington D.C. Adam, your turn.
ADAMHey, thanks, Kojo. Long time listener, first time caller. I just had a question for -- well, I guess the speaker or maybe the group in general. My only question is it sounds as though this particular disease is something that no one has immunity for. And if no one has an immunity for it, then the truth is that we're all going to get this at some point unless a vaccine takes place. So I'm just confused as to why we're trying to prevent exposure, when in truth there's no way to eliminate all exposure.
ADAMEven the caller has said -- or the speaker has said that we're going to get this. There's no way around it. We can try to mitigate the risk. We can try to eliminate the hazard as much as we can, but the truth is that everybody is going to get this. Nobody is immune to this and we're all going to get it. The sooner we get it the better.
NNAMDII am not sure that your version of the truth is what Dr. Leana Wen was saying. So I'll let her speak for herself. Dr. Wen.
WENI appreciate the question, because it is one that people ask, right? And, Adam, I think that I agree with you on some elements that this is a highly transmittable disease. It is -- none of us have immunity to it. And so if you let the virus go unchecked, it's true. We are going to get it. But if that happens what ends up as the result if we all end up getting ill all at the same time, we are going to overwhelm our healthcare system. Our hospitals cannot handle the number of people who would become severely ill from COVID-19 all at the same time. That was the purpose of flattening the curve.
WENThat if we're able to space out the infections over time, we can avoid overwhelming the healthcare system. And so we can still have a functioning society. Ideally we're also able to string out the rate of infections until such a time that we can get a vaccine. And we believe that we can do so, it's not inevitable that we will get COVID-19. It's inevitable that there will be the risk of getting COVID-19, no doubt. And that the risk depending on what you do and what you're exposed to can be higher than others.
WENBut ideally we're able to string out the rate of new infections, and by doing so reduce the number of deaths, particularly for the most vulnerable, but again, I think this is another misconception. People think that because we've been talking about the elderly and those who are immune compromised and with chronic medical conditions as being the most susceptible, and that's true. But we're also seeing children, who have gotten critically ill. We've seen young adults and otherwise healthy people who even have debilitating strokes from which they never recover and die from COVID-19. And so we should all be taking this very seriously and again, doing our best to prevent that rapid spread of the illness.
NNAMDIWe got a tweet from Alinato. "I have friends who are traveling to another state to see their healthy parents, who are over 60. This seems reckless since my friends will have to go through airports, gas stations, etcetera. Am I right?"
WENI mean, it's challenging, again, because everything that you do that involves interacting with other people is going to have risk. I would say right now driving is going to be safer than especially a long haul flight. And that's because if you're going on a plan you can imagine all the places that you're going to be where there are a lot of people, the airport, maybe an Uber or a train to get to the airport.
NNAMDIOnly got about 20 seconds left before our break, but go ahead.
WENSo you can reduce your risk if you're going to be driving including washing your hands very carefully, sanitizing surfaces, wearing a mask and keeping physical distancing where you can, and then quarantining yourself on the other end before you see your elderly parents.
NNAMDIOkay. Got to take a short break. We'll be right back with Dr. Leana Wen. I'm Kojo Nnamdi.
NNAMDIWelcome back. It's your turn. We're taking your comments and questions about the coronavirus for Dr. Leana Wen, Emergency Physician and Professor of Public Health at George Washington University. She formerly served as Baltimore's Health Commissioner. Dr. Wen, this past weekend crowds flocked to Ocean City, Maryland among other coastal destinations. I'm wondering what went through your mind when you saw those photos of the boardwalk with very few people social distancing or wearing masks?
WENI saw them as potential patients. I saw also what might happen if they go back to their communities and infect their families. And really I was thinking that that -- those pictures that we saw could be the picture of the next outbreak. And I also thought about how difficult it would be for contact tracers. Imagine if you are in a crowded location. The boardwalk where people are passing by, the level of exposure actually is pretty low even with not so great social distancing, because people are at least walking by.
WENBut I really worry about the Lake of the Ozarks pictures of people gathering at the beach or at the pool in a small enclosed space all at the same time for a long period of time. And I think of how difficult it would be for contact tracers to figure out who was exposed. And how many dozens, hundreds, maybe thousands of new infections would have resulted from that behavior. And, again, I understand that people have been pent up. I understand that frustration that people have had.
WENBut I also don't want to see all the sacrifices that so many have made go in vain because we've given up so much to get to where we are. And we really need to keep up that physical distancing because that's the single most important thing we can do to reduce the rate of transmission.
NNAMDIHere's Laverne in Washington D.C. Laverne, your turn.
LAVERNEYes, hi. Thanks for taking my call. My question is I would like some clarification as to when someone should show up to the ER or the hospital in general if they believe they have COVID. We get messages saying and this is on answering machines when you call the ER saying, "Do not show up to the ER. If you are experiencing what you consider COVID symptoms, contact your primary care physician or get on their website for the answer to further questions." This is 10:30 at night and not everyone has access -- a 70 year old may not have access to the internet.
LAVERNEWhy is it that people are being asked and told to wait until I guess their deathly ill or I don't know when to show up to the ER? By the time they get to the ER they require a ventilator. Wouldn't it make sense that people come in when they believe they're experiencing symptoms of COVID. Get tested. Get supportive treatment if they need to. Therefore they could avoid decompensation to where they need the ventilator?
NNAMDIWell, allow me to have Dr. Wen respond to that. Dr. Wen.
WENYeah, I understand the frustration and I would say that this is also a work in progress. So what I say now will be different from what it might be in a couple of months' time or ever a couple of weeks' time, because the guidelines around treatment and also of hospital flow is going to be different. Here's the rule of thumb about emergency rooms. Don't go to the ER unless you would have gone anyway were it not for COVID, right? The ER is for emergencies.
WENAnd so if you're having severe shortness of breath and cannot catch your breath, if you're having chest pain of any kind, if you're having stroke like symptoms and can't move a side of your body, I mean, things like that that are emergency symptoms you should absolutely go to the ER. Helpful to call in advance to let them know that you think that you might have COVID, because they might have certain procedures to take in patients who have COVID or possible COVID so as to prevent your exposure to other patients and to staff.
WENBut, you know, if you're truly having a life threatening emergency, absolutely you should go to the ER. The issue is that you should not be going to the ER just because you think you have COVID, because the ER is not the right place to get testing for COVID. The procedures are going to be different depending on the jurisdiction that you live in. But doctors' offices definitely is the first place that you should be calling to find out about how you could get access to that testing. That's not going -- the right place for that is not the ER. And I think that's what that message is meant to send.
WENThe other thing too is if you have mild symptoms going to the ER is not going to be helpful, because all you'll be told is to go somewhere else potentially for testing. And that you should be recovering at home, because right now as of now there is no particular treatment that we would be giving. It's not like you have pneumonia and we would be giving you an antibiotic if you went earlier and it would help you recover faster. Rather we would be giving you what's called supportive treatment telling you to go rest, drink lots of fluids, take fever reducing medications and to see your regular doctor. So go to the ER for an emergency. Don't hesitate to go if you have an emergency, but otherwise call your doctor to get tested.
NNAMDIAnd thank you for your call, Laverne. Here now is RC in Washington D.C. RC, your turn.
RCThank you. Yeah, Dr. Wen, I was hoping to get your assessment of risk for these activities, pickup basketball indoors, pickup basketball outdoors, riding a bus or a Metro train.
WENSure. So again, nothing that you describe has no risk. And so this is how I would consider it. So anything outdoors for that same activity is going to be safer than that same activity indoors. So certainly basketball outdoors will be safer than basketball indoors. It depends on how many people you're playing with. If you're playing only with your family members you will have no risk, because you're living with them anyway. If you are playing with other people, there actually is substantial risk, because you're touching the ball. You're also in close proximity with others as you're playing basketball and you're breathing heavily at that same time.
WENSo either outdoors or indoors I actually think that is a relatively higher risk activity that I would advise avoiding at this time. And instead practice by yourself or with members of your own family. Riding a bus or taking other public transportation, you should do if you have to do it as in if you have to do it to get to work, you should do it. And reduce your risk while you're there.
NNAMDIWear a mask, bring hand sanitizer, etcetera. I would highly advise though that for those who don't have to ride the bus, don't do it because that way you're actually giving more space on the bus for others who have to take it for work purposes. So that's something that we can do recognizing that social distancing is a privilege that not everybody has.
NNAMDIThank you for your call. On now to Ahkmed in Maryland. Ahkmed, your turn. Hi, Ahkmed, are you there?
AHKMEDYes. I wanted to ask a question for family members, who is in a nursing home. They're cut out of their loved ones and some of them lose their loved ones without seeing them. Is there any way that we can have some sort of communication? It could be Facetime, video time and so that, you know, family member would have a chance to meet their parent or loved ones. Thank you.
NNAMDIThat probably depends on what the nursing home allows you to do, but Dr. Wen.
WENThat's right. I mean, I do think it's one of the great tragedies of our time with COVID that people are cut from their loved ones. That individuals, who are very ill are not even able to say goodbye in person. And residents in nursing homes are being cut off really in a very -- it's extremely frustrating and extremely sad to see. And I think that if we cannot have the face to face time then we should have tried to at least have that face time via actual Facetime or Skype or something else. And I definitely would recommend you asking the nursing home for what procedures they might have to facilitate those types of interactions.
NNAMDIOn now to Susan in Washington D.C. Susan, your turn.
SUSANHi. I'm concerned and wondering about the lack of requirements or public health messaging about social distancing and masks in residential apartment buildings. It's terrifying. There are a number of older and vulnerable people in the hallways that other people are encountering constantly without masks. People feel that they're at home and they don't need to wear masks.
NNAMDIAnd you're saying that there are no notices in some apartment buildings about either social distancing or masks?
SUSANExactly, no requirements in my building. I've been fighting for months.
NNAMDIOkay. We only have about a minute left. So allow me to have Dr. Wen respond. Leana Wen.
WENYeah. I mean, you're absolutely right, Susan. There should be notices and ideally even requirements in these buildings. Buildings that have elevators should have maximum occupancy requirements. I would say that if you're in such a situation definitely lobby to your landlord. Get others to sign a petition if necessary. And in the meantime reduce your own risk by trying to travel -- going outside during these off-peak hours as much as possible to protect yourself even if the policy hasn't changed yet.
NNAMDIPatsy writes, "Can joggers, who are breathing heavily when they run past me without a mask and with less than six feet between us spread the virus to me?" We only have about 30 seconds left.
WENTheoretically yes, but that level of exposure is going to very low, because the time of exposure is so low. And so, again, try to move out of the way as much as you can. But there has been no documented case of somebody getting COVID from somebody passing them while jogging.
NNAMDISo that's about all the time we have. Dr. Leana Wen is an Emergency Physician and Professor of Public Health at George Washington University. She formerly served as Baltimore's Health Commissioner. As you may have guessed by now she has become our go to physician for questions and answers about coronavirus. So Dr. Wen, thank you so much for joining us.
WENThank you, Kojo.
NNAMDIWe're going to take a short break. When we come back, moral philosophers weigh in on how we can make ethical choices even in the midst of a pandemic. I'm Kojo Nnamdi.
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