Bernie Sanders Town Hall Coronavirus Transcript with Public Health Experts

Bernie Sanders: (00:00)
Pramila Jayapal. And as many of you know, Congresswoman Jayapal is from the state of Washington and that is one of the epicenters of the pandemic. And we’re going to talk to the congresswoman about what’s going on in Washington, where they are at right now, where they hope to go, what other states can learn from the tragedy that is impacting the state of Washington right now.

Then we’re going to go to one of my favorite musicians for a short break because technologically, we need some break here to go to our next guest and that’s Sarah Lee Guthrie and some of you may know, she is the daughter of Arlo Guthrie and the granddaughter of one of the great folk singers and writers in modern American history, and that is Woody Guthrie. And she’ll be singing for about five minutes and we thank her very much.

Then we’re going to go to Dr. Abdul El-Sayed, who is a physician, epidemiologist, public health expert, former health commissioner for the city of Detroit. And I think we’re going to ask Dr. El-Sayed to play family doctor tonight; to answer the questions that are on people’s minds about how the disease is spread, what happens if you get it, where you go. And by the way, at the end of the program, we’ll be welcoming your questions. You can ask me questions, but probably you’d want to ask the doctors. They know a little bit more about it than I do.

After we hear from Dr. El-Sayed, we’ll hear from Dr. Rishi Desai, who is a former epidemic intelligence service officer in the division of viral diseases at the CDC, a former pediatric infectious disease fellow at the University of Southern California, and is currently the chief medical officer of Osmosis, a healthcare education platform. And then we’ll go to Dr. Joia Mukherjee who is an associate professor of global health and social medicine at Harvard Medical School, associate professor of medicine at Brigham and Woman’s Hospital. And although she’s joining us tonight in her personal capacity, since 2000 she has served as the chief medical officer of Partners in Health.

Before we get to our guests, what I want to do, which I think is on people’s minds as well, is briefly go over the package that the Senate is working on as we speak. I expect that I’m not going to have to run out for a vote, but if you see me depart, that’s where I’ll be going. But they are putting the finishing touches on the largest financial package of new money in the history of the United States. I expect the package will be over two trillion dollars, and that excludes many trillions of dollars coming from the Fed. The idea of the going big is something that not everybody agreed with at the beginning of this discussion; something that I thought was absolutely imperative. And I’m glad that we’re coming up with some serious money to address an unprecedented crisis.

Let me just very briefly go over some of the details. The best I can tell you is this is latest information that we have. Things change all of the time. Literally, negotiations are going on as I speak. We’re talking about 250 billion dollars to be provided to expand unemployment insurance. This is something … A concept I fought for. My belief is that in this crisis, we got to make all American workers whole. This bailout should not be just for large corporations. It should be for working families, for lower income people, and for the most vulnerable people in our country. This unemployment provision will essentially allow furloughed Americans, those who have been laid off, to receive 100% of their prior income capped at 75 thousand dollars a year for up to four months.

Importantly, at a time when fewer than half of Americans are eligible for unemployment, to the best of my knowledge this covers gig workers … You’re driving an Uber car, you’re covered. You’re a waitress, you’re covered. This covers, to the best of my knowledge … Now, there may be things that I don’t know here … The best of my knowledge, virtually all American workers. Furthermore, some of this money will go to work-sharing programs that will subsidize the wages of employers who don’t lay off workers. So, if an employer keeps that individual working, they will get a full payment for the salary of that worker. This proposal will provide 250 billion dollars in a one-time check of 1200 dollars for adults and 500 dollars per child. I wanted much more, frankly. I thought we needed 2000 dollars a month. Republicans essentially wanted a lot less. That is where they are right now. And these checks will be made out to individuals making less than 75 thousand a year and households making less than 150 thousand.

There will be 350 billion dollars to go out in forgivable loans to small businesses who do not lay off workers. It’s an idea that some of us have been pushing and that is if you’re an employer, this case a small business person, you don’t lay off your employers, you’ll get a forgivable loan. It starts off as a loan, you hang onto your employees, that loan will be forgiven. At a time when states are losing revenue, tax revenue big time. Cities as well. There’ll be 150 billion dollars that go to states and cities and counties. There will be 130 billion dollars provided to reimburse hospitals for lost revenue related to the Coronavirus. Hospitals now, all across this country, are stretched out. They are losing revenue. They’re going to have to expand their capabilities to take care of an influx of people who have the virus. This will be a shot in the arm for hospitals all across this country.

Now, what is the most problematic aspect of the bill to me is that 500 billion dollars are delegated at this point … I don’t have all the details now, they’re still being worked on … But to be distributed to businesses at the discretion of the treasury department. And the concern here is 500 billion dollars is a huge amount of money. The republicans originally wanted a blank check to get that money to anybody they wanted in any way they wanted with virtually no transparency. People would not know who got the money, what the terms are, for a very, very long time. And the fight right now is to say, “You know what? If you’re going to provide people to these large corporations, we want to know how that money is being spent. We don’t want stock buybacks. We don’t want you to be raising the salaries of your CEOs. We want the money to go to workers. We want the money to be used in a productive way and the American people have got to know right away, with transparency and oversight, how that money is being spent.”

There is also a provision in there … Again, I have problems with this … For free testing for the Coronavirus. You can get tested for free but not free treatment. My own view, which did not prevail in this discussion, is that in this emergency moment every American should be covered by the federal government for healthcare. And that means Medicare for those people who have nothing or underinsured and to supplement the private insurance of people who have large deductibles and co-payments. But that did not prevail and I worry about this provision very much.

Our community health centers will receive 1.3 billion in emergency Covid-19 funding, which will help some of our primary healthcare providers. And there a number of other issues out there. Some that have not yet been dealt with as I understand it, is a moratorium on foreclosures and evictions. People should not be losing their homes, should not be thrown out of their apartments. I’m worried about what happens to the most vulnerable people in this country; the homeless, people in prisons. I’m not quite sure that that has been effectively addressed. It is absurd that we remain the only major country on earth not to provide paid family and medical leave. That has not yet been addressed so far. A suspension on moratorium on student loan payments, not addressed so far. Adequate nutrition assistance. You got a lot of people out there without the income they need to buy the food they need. That is pretty crazy. We got to make sure that the SNAP program is significantly increased. Not yet dealt with. And some other provisions as well.

That is a very brief outline of what is in a bill, which is not yet completed, which is still, as we speak, being worked on. What I want to do now is go to Congresswoman Pramila Jayapal from the state of Washington. And sadly, the state of Washington is one of the epicenters of the epidemic. And what I would like Pramila to discuss, if she could, is talk about how the state has responded to the crisis. Was that response adequate? What is the situation now? Does the state of Washington have the beds, have the ICU units, the ventilators that they need? Do the doctors have the gloves, the gowns, the masks that they need? Where do you think Washington is going to be in a few months? You’re right now in the middle of the crisis. What do you see happening in a few months? And maybe, Pramila, what can the rest of the country learn from the state of Washington’s experience.

Pramila, thanks so much for being with us.

Pramila Jayapal: (11:06)
Thank you so much, Senator Sanders, for inviting me to join you on this national Live Stream. And also, just for your continued bold leadership to address all of the challenges that we’re facing today. As you said, I represent Washington state seventh district and that includes most of Seattle. And I’m also very proud to serve as your national health policy chair for your campaign and the lead sponsor of the House Medicare for all bill. These have been incredibly difficult days for the entire country. And across the country, what we’re seeing is over 44 thousand cases and 544 deaths.

In Washington state, we were hit early. First case diagnosed was here in Washington just right outside of my district. And as of yesterday, we had 2200 cases and 110 deaths, so that’s 28% of all the fatalities in the country. Our state and local officials have acted very smartly, very boldly, very proactively and frankly, we’re fortunate that we have a public health system in Washington state that is, in my view, one of the finest in the country. And it’s because our democratic governor and state and local electeds have continuously invested in that public health system and consistently linked to science and research even as the federal government dis-invested consistently across the country. And so, that allowed us to be ahead of the curve a little bit; to be processing the most tests per capita in the country by getting a testing lab, the UW Virology Lab up and running at the University of Washington, that by the end of this week will be processing about 5000 tests per day along with the state health labs. And-

Excuse me. Say that again. You’re going to be doing 5000 tests per day?

Per day.

Wow.

And that sounds like a lot compared to the rest of the country, and it is, but I will tell you it’s still inadequate for what we need. The other piece that I would say, Senator Sanders, is that our history in this city and in this state of leading with progressive policies in ideas has meant that our response is far better. So, as you know, we were the first major city in the country to pass $15 minimum wage. We have some of the most inclusive immigration policies. And what that meant is that our movement was able to quickly move ideas like statewide and local moratoriums on evictions, which you mentioned we’re trying to get at the federal level as well, rental assistant subsidies, and addressing [inaudible 00:13:52] issues within our criminal justice system.

We’ve put in place many of those protections at the city or, in some cases, at the state level. But the challenge is two-fold. First, that we are still very far behind where we need to be. And part of that is a far too uncoordinated federal response to getting critical protective equipment, PPE we call it, and ventilator supplies to us. You mentioned hospital beds. We have dramatically low hospital bed capacity as well as isolation and quarantine facilities to deal with the crisis. What we are now doing … Because some of our hospitals are 80, 90, even 100% of capacity, we will be getting some federal assistance from DOD to set up some temporary hospital … Or medical facilities. What we will do is move some of the people that just don’t need the hospital equipment into those kinds of DOD tents, health tents, so that we can preserve our hospital beds and our ICU beds for those who need them the m-

Medical personnel have the masks and the gloves and the gowns they need?

They do not. They do not. Just today I was able to get another 4000 masks from our port, which had … The port of Seattle had some extra masks. We’re literally going around begging for masks because this goes to an important thing. The government needs to utilize the Defense Production Act and actually use it to demand and support domestic manufacture and purchase of massive amounts of what we need. I mean, we need millions of these things and we’re still letting the private sector drive the marketplace. We’re not expanding supply sufficiently and our states are bidding against each other on critical items like ventilators or masks. We also can’t keep our health workers safe, which is crucial, but there’s other first responders also and I include in that, by the way, grocery store workers, bus drivers, others who have to continue to keep our systems going.

The other challenge, senator, is the scale of the crisis and the losses that are going to accrue to an already deeply unfair, unjust and inequitable system that has already, for decades, actually, penalized black and brown workers, low wage workers, poor people and the most vulnerable. We need immediate support to people right now, but we also have to fix the overall systems that made us so unprepared-

Right.

-And vulnerable in the first place. And there’s a real tension that you are seeing in the senate bill, that we will see in the bill that we have to vote on, between using existing systems to quickly deliver as much as possible, in terms of direct cash support and benefits, expanded unemployment insurance, all of those things, which is incredibly important. But those systems still leave out a whole host of people, even if we expand them to the maximum. And so, the recognition that our systems are far too patchwork and there’s a whole set of missing federal policies that are big enough and bold enough; the things you’ve been advocating for on the campaign. Things like universal healthcare, missing systems that provide mandated paid family and medical leave, universal childcare-

Right.

-Some sort of a payroll guarantee system to keep workers on payroll instead of going to unemployment in the first place.

Right.

Comprehensive and humane immigration reform so that we wouldn’t have to worry that immigrants are left out of anything. And of course, broad and strong collective bargaining provisions that allow frontline health workers, like those healthcare workers who are right now sort of at the mercy of hospitals who decide whether or not they’re going to get their masks, whether or not they have to reuse their masks, all of those things. We need those collective bargaining provisions that would allow for a strong worker policies.

If we had Medicare for all in place, we would have been far better prepared to handle the crisis. It’s centralized, which means we can respond quickly. It’s universal, which is necessarily in a public health crisis as well as all the time. You can quickly contain the cost with negotiated prices of drugs and vaccines and equipment that’s needed. And of course, combined with free higher education, something else that you’ve been advocating for, countries that have both of those things can have a broader and deeper public health pool to draw from. And of course, the Medicare for all-

Pramila, let me interrupt you and just ask you to please hang on there. I want to get to some of the other … The medical people, and then we’re going to bring it back for a general discussion. Can you hang in there with us for a while?

Sure, I will.

Okay. Thanks very much for that report from one of the epicenters of this crisis. And now, we are going to go to our singer, who is Sarah Lee Guthrie. And Sarah, take it away.

Speaker 1: (19:14)
[inaudible 00:19:14].

Speaker 2: (19:38)
Lights out.

Sarah Lee: (19:38)
[inaudible 00:19:38] and you are watching my Bernie 2020 musical session. Enjoy.

Sarah Lee Guthrie: (21:45)
( singing)

Okay. Let me thank Sarah Lee Guthrie for the music. Let me remind the viewers that if you have any questions for the doctors for me, please send them right in. Now let me introduce Dr. Abdul El-Sayed, who is a physician epidemiologist, a public health expert and he’s the former Health Commissioner for the City of Detroit. And Dr. Sayed, what I’d like you to do tonight if you could, is we have many hundreds of thousands of people viewing this program. Why don’t you act as the family physician for them in terms of explaining how the disease is transmitted, what we can do as individuals to stay safe. So why don’t we start with that one.

Dr. Abdul El-Sayed: (26:00)
Absolutely. Thanks Senator. So what we’re talking about here is a virus. And we talk about the name coronavirus, but that’s actually a misnomer. Coronavirus is just a class of viruses, other coronaviruses were SARS and MERS. This is just one particular one. What it causes is a pretty prescribed set of ailments, including a fever and a dry cough, a viral pneumonia. And this viral pneumonia is the part that’s that’s deadly.

It’s substantially more deadly and a lot more dangerous, the older you get. Certainly after the age of 65, the risk goes up exponentially for a bad outcome with it. And for folks with underlying chronic diseases, particularly lung disease, it can be really dangerous. What we are all doing right now is protecting ourselves through physical distancing, or social distancing. And the goal here is to protect our health system from an onslaught, an onrush of cases, that could overwhelm the healthcare system.

How does it get transmitted? Well, either people being in proximity with each other, breathing the same air, little microdroplets that come out of your nose and mouth, or it can be shed and then go on to surfaces. And new research suggests that it can actually last on those surfaces for some time.

And let me as you this. If I could, I’m going to play the dumb bunny here. I struggled with biology in college though it’s going to manifest itself now. But I can understand if somebody who has the virus sneezes in the face of somebody else, you cough in somebody’s face, the virus is transmitted. How is it transmitted if I’m simply in a room where somebody has the virus but is not coughing, is not sneezing. How could it be transmitted in that situation?

Yeah, the most common thing is, we don’t really register this, but we touch our faces all the time. And from the limited amount of information that we actually do have with this virus, it’s a pretty young virus, it’s only been in humanity for five months now, is that it actually sheds in what we call high titer. But a lot of viruses can come out. And we touch our nose and our face all the time. If you’re just watching these screens you’ll see us doing it.

Right.

And when you touch it, then you will touch somebody else’s hand and they touch their face. You may be touching something. These phones that we all have on us can be a real nidus, because we’re constantly touching them and touching other things. And so that’s usually how it happens. The sneeze scenario is the one that everybody knows. You’ve got somebody who’s coughing quite a bit. In fact, in this particular case, it’s not really a sneeze, it’s the cough. And you know to stay away from them.

But also, what we’re starting to understand is that there’s probably a high probability that this disease can go asymptomatic in certain people. And in those asymptomatic people, they may be in fact spreading it, even though they don’t have symptoms. And so this is the really concerning situation. Because people know that if I’m sick, I stay away from other people. It’s a kind and conscientious thing to do. But if you don’t even know you’re sick, then you may not be doing those things. And so you may be out and about in the world.

And that’s why it’s so important that we socially distance. Because we may not know if in fact we are carrying the disease and may be passing it on to other people. And so it’s really critical that we stay home. And that is the key advice that we’re hearing everywhere. We’ve seen about a hundred million Americans are now under stay at home orders for that reason. And the key point, Senator, that I think has to be made again. And we’re hearing it everywhere, but I want to say just one more time, is that in young folks they may think, “Well, my risk of a bad outcome isn’t all that high. So if I go out, I might get it, it’ll be okay. I’ll feel safe, and I’ll be fine.”

The problem though is that you may become a nidus, you may become the transporter of that virus into somebody else who could make them all sick. And make them very sick.

And may not even know it. Is that correct?

That’s exactly right. And so we’ve got to pretend like we have the disease and we don’t want to pass it on to people we love, who could have a really bad outcome. And then on top of all of that, the key point about flattening the curve, and I have to say it one more time, is the key point about flattening the curve is that we only have certain levels of healthcare resources. We were talking to Congressman Jayapal, who was talking about the limited amount of personal protective equipment on the front lines for healthcare workers.

And if we spread the disease fast enough, if we can’t delay the spread, if we can’t reduce the number of people who get the disease, then it may overwhelm our healthcare system. And we’re seeing really scary things out of Italy and Spain where doctors are literally having to make decisions about who lives and who dies because there’s only one respirator and two, or three patients who need it. We don’t want to get there. And so it’s really important for us to make sure that we are not a part of spreading the disease. And this disease is actually quite contagious.

On average, two and a half people will get the disease from every one person who gets it. And if you think about all of those two and a half people spreading it to two and a half more people, over time, you’re talking about thousands and thousands of people. And so we, even if it may not be a serious case in us, we’ve got a responsibility to protect the rest of us. And it’s really, it’s essentially your message, is that we’re in this boat together. What we do together, what we do individually influences the lives and a lot of the goods of other people. And we’ve got a real responsibility to protect all of us.

All right, doctor, go through the symptoms again. How does somebody know that they may have the virus?

So, we always look at exposure. Did you come in contact with somebody who had it, was presumed to have it. But the symptoms themselves are a fever, and a dry cough. So when you think about a productive cough, you cough and stuff comes out, that’s a productive cough. It’s not that cough. It’s a dry cough. And then in serious cases, folks complain of shortness of breath. They can’t pull it a full breath. And that’s when it gets really serious.

In fact, for most people, if you have these symptoms and they’re not serious and you don’t feel like it’s really taking your breath away, then the best thing to do is isolate and stay home. But in those folks who feel like they’re really short of breath, “I can’t take a full breath and I’m worried about my ability to actually take oxygen in.” In those folks that can be really serious and folks need to come to clinical care in those circumstances.

Doctor, if somebody develops the symptoms, not the most serious symptoms, is there any treatment, or do you just stay home and rest?

If it’s not serious symptoms, then stay home and rest. And the same things we always tell everybody when they’ve got a viral illness. Make sure that your symptoms don’t get more serious, and if they do, then you need to go get care. But, make sure that you’re drinking fluids. Make sure that you’re certainly socially isolating from folks, so you’re not passing it on. Make sure that you are taking care of yourself and getting the rest that you need. But usually those symptoms subside.

But in the cases that they get serious and certainly in older folks, who think that they may be exposed and may be having symptoms, they’ve got to call their doctor. And then being communication with their doctor because they may need serious care. And for folks who do get a serious case, the most important thing we can do right now, there are clinically proven treatments for this. The most important thing we can do is keep them ventilated. And for some cases, in very serious cases, they may have to go on a mechanical ventilator to keep them breathing, keep them oxygen native while their body develops the immune response to be able to take on this virus and kill it away.

What is your best guess as to when a treatment might surface, or a vaccine might be developed?

So the first candidate vaccine went into phase one trials. And let me just walk folks through how this works. You’ve got three phases in a vaccine trial. The first is we just want to make sure that this thing doesn’t hurt you and that it’s creating the immune response that we expect in your biology. And that part of the trial, it’s the longest part of the full phases. It’s the longest phase, it’s 14 months. After that, phase two and phase three, and phase three is where we actually test whether or not it’s efficacious and it protects people from the disease, that can be done in about four months. So from two weeks ago, best case scenario, we’re talking about 18 months to have a vaccine.

And then you have to manufacture the vaccine. And when we’re talking about something as serious as coronavirus, that’s affecting this many people, you’re talking about creating, or manufacturing that amount of vaccine at scale, which is not easy to do. And so vaccine, it’s not right around the corner. There are some treatments that have been proposed. There’s one that a certain politician keeps trumpeting, but they haven’t been tried in rigorous trials.

So what makes modern medicine modern is that we use evidence. We ask, “Does this consistently change an outcome for a group of people if and when we’ve randomized people to getting this particular drug.” And And unless we can show rigorously, in different trials, in different groups of people, that in fact having this particular medication reduces the symptomatology, or the length of disease, then we don’t consider it evidence-based and we don’t enter it into the Pantheon of treatments that we use.

Now, it may be the case that you use things on the front lines because patients are really sick and you’re trying everything. But to say that there are treatments out there for coronavirus, specifically would be irresponsible based on the reading of the science.

And you know that that named politician would never do such a thing. Right? We know that. We know that. All right. Doctor Sayed, thank you so much. If you could stick around for some questions and discussion. Appreciate it. Our next panelist is Doctor Rishi Desai, who is a former Epidemic Intelligence Service Officer in the Division of Viral Diseases at the CDC. Doctor Desai, thank you so much for being with us.

Dr. Rishi Desai: (36:20)
Thank you. Yeah, I really appreciate the opportunity to speak about COVID-19 thank you for having me, Senator Sanders.

What is your sense of how our country and the world are doing in terms of treating this epidemic, this pandemic? It sounds to me like we have not been particularly well prepared for it, or am I missing something?

No, I think that’s a fair assessment. So we learned about COVID-19 from the WHO at the end of last year. That’s why it’s called COVID-19, 2019. So it’s been around and has been known about since then. Since learning about it, different countries have reacted differently. And we see that the policies that they put in place have effected their outcomes. So let’s look at countries like China, South Korea, Singapore. These countries have taken certain measures. They’ve been very quick to jump on this disease. They’ve started flattening the curve. You heard that phrase just now.

And what that means in short is they’ve said, “Let’s create travel restrictions, let’s create work restrictions. Let’s isolate and shut down nonessential businesses. Let’s take this really seriously.” Because again, you want to make sure that epidemic curve, which is to say the number of people that get sick per day is as low as possible.

And then the other thing is, and the other half of this, and I to introduce a phrase to you to help summarize how I think about it, is to raise the line. And that line is on that same graph. You’ve got a healthcare capacity line. You want to raise that as high as possible. You want to raise the line. You want to flatten the curve. And together you can help handle this situation. These first countries did that. And if you look at it now, China is essentially now coming out the other end of the tunnel. They’re doing a great job of saying, “Hey, we’ve got fewer and fewer cases domestically. Let’s make sure we don’t re-import cases from the rest of the world.”

Right now, the U.S. today has more cases of COVID-19, new cases today than any other country in the world. That’s just today. By this weekend we’ll have more cases than any other country cumulatively, including China. So by this weekend we’ll have achieved that very, very sad benchmark. And so the reason is we’re not in that first group of countries that took this very seriously. We knew about it when the rest of the world did, but instead of acting in that same, aggressive way, we instead did something different. We initially said, “Well, it’s not a big deal.”

Well it’s not, “We”. let me interrupt your doctor. I don’t intend to become very political tonight, but it’s not the, “We.” We had a President of the United States who downplayed this, who is still in my view, downplaying it. Is that a fair statement?

It’s fair. And just as you said, I don’t want to take any blame for this myself either. So I hear you completely. I agree. I don’t mean it in the collective, we of let’s say both parties, or anything like that. I just mean in the sense of we as a country, and however that plays out. You’re totally fair to say that.

But the truth remains that U.S.today hasn’t done the thing those other countries have done. And that’s the big challenge. Is saying, “Look, we know every country is going to have to shut it down.” And when I say shut it down, I mean shut down all nonessential functions. We know this has to happen. We might have hem and haw on our way there. Italy did that initially. Spain, Germany, at the end of the day, all of them did the same thing. And here’s the key. The longer you wait to do it, the longer you have to do it for. The longer you have to do it for, the more your economy suffers.

Let me ask you this, let me interrupt you and ask you, and again, I don’t…

[crosstalk 00:40:01]-

Let me ask you this? Let me interrupt you and ask you… Again, I really do not mean to be political here. This is a health issue. But you got the president saying, look, he’s worried about the economy. We’re all worried about the economy. He’s saying, well, maybe in a few weeks we’ll start reopening the economy. Start bringing people back to work. You’re shaking your head, I gather you don’t think that makes a lot of sense.

No, I think that’s not a smart strategy. I think the right strategy is to say, “Look, let’s just handle the problem the way it has to be handled. Let’s shut down for as long as we need to and see the number of new cases fall.” At that point we start even beginning to think about when and how to reopen things. At the moment we’re at a very critical juncture where, we just heard from the representative from 7th district in Washington, Jayapal who is speaking very eloquently about the challenges they’re facing. Washington in many ways, it’s kind of the Wuhan of America. They’re the Canary in the coal mine. We’re lucky that there is savvy as they are in terms of the science on this, very lucky.

We need to learn from what they’ve done and what they’ve done right. To make sure that gets implemented federally on all levels. In terms of raising the line, Senator Sanders, you yourself have made a big issue of handling unemployment, making sure that we forgive student loans. All of that makes 100% sense. What I would say is that as much as possible creating a pipeline where we can get new frontline healthcare workers to wear those N95s, to use those ventilators. Because again, having all that equipment without people is not useful, right?

Explain to me… Let me interrupt you. Let’s talk about medical personnel. Let’s talk about… It is stunning to me how we don’t have masks. I mean one might… That kind of seems like a no brainer that this is not the first epidemic that we have seen. Mask are not all that expensive. How does it happen that we don’t have the masks, the gloves, the gowns, the other protective equipment that our frontline doctors and nurses need? I don’t know if you noticed this. I think in Italy, if I’m not mistaken, some 23 medical personnel have already died. I mean, that’s a tragedy unto itself. How do we defend and protect the American people if our medical people are sick or dying? How does that happen? That was so unprepared in that respect?

Well, very easily what I would say is there’s a national stockpile that national stockpile has a budget. That budget gets gutted when no one’s looking. So what’s happened is that essentially in the era where we didn’t have COVID-19, where we’ve had other priorities and there’s no political will for things like public health, those budgets get slashed and no one really kind of cares.

So is the function of that budget actually to prepare for disaster? Is that what it’s supposed to be doing?

100% absolutely. And then when there is a disaster, everyone says, “Well, where’s the stuff we needed?” Well, it’s gone because [inaudible 00:43:11] paying attention. The other thing that you said, which is critical. Italy had people that were dying, healthcare workers. When one person goes down, just one, that person was having lunch, going to dinner with workmates, doing procedures with workmates. All his workmates get quarantine mind you. Now you got a number of people that are quarantined. That initial person is sick, they may never come back.

And then you’ve got that third wave of folks that maybe weren’t quarantined or sick, but now they’re fatigued, they’re overstretched, they’re overburdened and they’re panicked because nobody has their back. Their hospitals don’t have their back. Their governments don’t have their back in terms of getting the right equipment, but are encouraging them to go in any way. So that’s a dangerous situation because God forbid those people decide not to go in. Now you’ve got essentially all the ventilators and the N95s you want, but you don’t have people that are able to kind of be there. So that’s the dangerous situation that we want to avoid by getting enough frontline healthcare workers in that space.

All right. My impression is that there are many parts of this country, forgetting the virus, that have for many years been underserved, right? There’s not an emergency room, there’s not a hospital. There aren’t enough doctors. What happens now in the midst of a crisis in those underserved areas?

Yeah, that’s exactly right. Before COVID-19 wasn’t in anyone’s vocabulary, before anyone knew about it. We already had a massive need for more healthcare workers. This was clear. Now COVID-19 came in and essentially exposed our very, very fragmented and fractured healthcare system and showed everyone how truly broken it is. So that’s really where we’re at, is we’re recognizing that those areas that are underserved are going to be hardest hit by this because they already weren’t quite hard hit to begin with.

All right. Dr. Desai If you could hang around for a bit and maybe take some questions and engage in a discussion, I would appreciate it very much. Our next panelist is Dr. Joia Mukherjee, who is an infectious disease doctor and public health expert. She’s an associate professor at Harvard medical school and chief medical officer at Partners in Health. Dr. Mukherjee, can you talk a little bit about what we can learn from what other countries are doing? What have countries done well? What haven’t they done well? What lessons might we learn from them?

Dr. Joia Mukherjee: (45:51)
Yes. Thank you so much Senator Sanders for having me on and I wanted to say that to your point of not being political, all health is political. I have been a public health practitioner and an infectious disease doctor for almost 25 years. Health is about the political choices we make. When we see that countries have been able to control epidemic disease, it’s because they are making political choices. Those political choices are always… If there’s a positive outcome, those political choices are about taking care of the sickest, taking care of the most vulnerable, taking care of the society. So I think what we’re seeing is that countries that have been able to control this are making choices about how to roll out public health and medical interventions.

So one of the things that concerns me having studied deeply what has happened in Wuhan China, what has happened in South Korea, Singapore, and Taiwan, is that they did not just flatten the curve. They did two things. Flattening the curve for anyone who knows a little math is about having the same area under the curve, which means the same number of people sick, the same death rate among people who are sick, perhaps slightly lower if you’re more prepared. But what China did, what South Korea did was more than flatten the curve. They flattened the curve with social distancing and some of the lock down and stay at home practices. But then they did something that we are not doing at all, which was broke the cycle of transmission. How did they do that? They did that by massive testing of even asymptomatic people of any contact who would get tested. And then if positive supported socially to quarantine or isolate safety. Isolation is what we use in public health for those who are positive, quarantine for those who may not be positive but may have had a contact.

You can’t ask people to stay at home if they have to work, if they have no food, if they have children to take care of and need to feed their families. So if we’re asking people to quarantine or isolate, we have to provide the adequate social support. But for people to know their status, what we saw in South Korea without any restriction of civil liberties, without any forced isolation, was massive testing. Testing to the point that for every 100 tests that were done, only two were positive. By definition in public health that’s a good screening test.

What we’re seeing in New York, Massachusets where I live and other places is 10% positivity rate, 30% positivity rate. That means there is silent transmission of the virus among the asymptomatic. It’s been told to us over and over again by many experts, well if you’re asymptomatic, stay at home or you’re non-asymptomatic stay at home. Of course, we don’t want people with COVID coming to the hospital and effecting others that they’re not very sick. But if we had access to testing, remote testing so people could know their status and then we could help them safely quarantine or isolate then we’ve done more than flatten the curve. Then we have [crosstalk 00:49:20]-

All right. Let me ask you this. Let me ask you this doctor, if you had your druthers, what would massive testing look like? What would it look like at Massachusetts and Vermont? What would it look like?

That’s what I’ve been working on solidly for the last week. Both for by the way, countries like Rwanda and Liberia where I work, where we’re trying to break the chain before it gets out of hand with the handful of cases we have. But in a place like Massachusetts, one could hire a huge cadre of contact tracer who could… We have massive problems now. People getting laid off, through load. They could be remotely checking on people. For every person who is infected, noting all their contacts, calling all their contacts and sending them to a remote testing site. You’ve seen these and they had many in Korea drive through testing sites. You get an appointment, you get the test. You’d have to then massively scale up testing, which we’re starting to do, but slowly, but we have to invest in it. So, [crosstalk 00:10:25]-

Question? Here’s a question, do we have the available test kits and are able to process results as quickly as we should be able to?

Sure. Because all health is political senator Sanders and if we had the political will, we could do it. That’s what was done in Korea. That’s what was done in China. Are they more advanced societies or richer societies than we are? Nope. They’re just making different political choices.

So we could do it. We have the capability-

Sure.

… and we have the expertise obviously to do it.

Absolutely. We developed many of these kinds of tests, polymerase chain reaction. There was just a rapid antigen test approved today by the FDA. There are tests in China that because of tensions between our countries, we are maybe not considering rapidly enough. I don’t know the politics there, but we have to make that choice and lives depend on it and flattening the curve in my opinion as a human rights doctor is accepting far too many deaths.

I want to get back to this issue of how quickly we can process the tests. The important point there is that somebody is sick but doesn’t have the virus, they don’t have to be in the hospital. You want beds for the really sick.

Of course.

How far advanced in being able to process these tests in a few hours?

I think there are labs now that are processing them in as little as two or three hours. But the problem is the backlog. So I have a good friend who was a known contact of a COVID patient and this is a very common story and waited five days for a test. Living in a household with vulnerable people. I mean that is not an acceptable thing in the richest country in the world. That is a political choice.

All right. What did I not ask you or did you not discuss that you like to [crosstalk 00:52:26]-

I guess the one thing I would add as a public health professional is we have made other political choices for many years to dismantle our public health infrastructure. So it’s not only epidemic response. It’s troubling public health nurses, civil servants. People who do outbreak investigation, who support the vulnerable, who understand where people live, that cadre of workers. Departments of public health all over the country have been over time, for the last 30 years defunded. We don’t have a good system of public health. Again it’s very state by state instead of having a strong federal system, EIS officers like Dr. [inaudible 00:53:17] are some of the most brilliant people we have. But this program needs to be far more robust to handle the crisis that we face. So whether it’s state departments of health, local departments of health or the federal mandate, I just think we have just invested in so much of our public infrastructure that it puts us tremendously at risk.

This is part of the overall anti-government movement of the last 30 years.

Yes. And again, I believe these are political decisions.

One last question for you. Should we worry about folks in prisons, in homeless shelters, et cetera, are they particularly vulnerable?

Absolutely. I am strongly in favor of trying to have amnesty programs for people who have had nonviolent offenses. We have far too many people incarcerated as it is. Certainly, it is unfair to put this burden on them. Health care for incarcerated people is is a very shameful thing in this country and I’ve done a little bit of work in some states in the South in prison related health care issues. There is no real ability of people to get proper healthcare and the conditions are awful. I think this is just an inhuman thing. Again, I think we’re judged as a society by how the least of us the most marginalized, the incarcerated and this is the work that I believe needs to be done by all of us.

Well, thank you very much for your comments and please join us, we’re going to get… There’s some questions beginning to come in and let me throw them out here. I’m going to mispronounce names, but we have a question from [inaudible 00:55:08] who writes quote, “I am a psychologist and witnessing people falling apart. This is serious and we cannot get out of it easily. What are we willing to do for mental health?” A very, very important issue. The stress level in this country now is probably at an all time high. People are worried about themselves, their families, their jobs, whether they’re going to have any income. We’re going see, I’m sure a spike in an already epidemic of mental health crises in this country. Panelists, who wants to chime in on mental health?

Well, I can take a shot. I mean, I really believe that part of the rebuilding of our public trust and the way we look at the public provision of care has to include mental health services and in this epidemic and in this stressful time, could we look at aligning some of these economic incentives with actually improving it, expanding access to healthcare. That means mental health care too. We’re really thinking about how to tie that in to some of the work we’ve done with COVID-19. I worked in the Ebola crisis in West Africa and we did a lot of work with Ebola survivors and a lot of it was mental health work because it wasn’t only the acute illness but it was a long term suffering that had been meted on their families.

Okay, cool. Who else wants to jump in on mental health issues

I’ll just say that our governor asked for an emergency declaration from the president and we just got part of that granted, which allows us to expand crisis counseling. We did not get disaster, unemployment insurance and other things like that that we asked for. We’re still waiting, but the crisis counseling allows the state to take action to get more of that counseling. We’re going to need more resources. All of those things. State stabilization, but it is front and center because people are already feeling that come April 1st is going to be a whole world of hurt because there are a lot of people that aren’t going to be able to pay bills.

Pramila are you sensing among your constituents more anxiety than was the case with a few months ago?

Enormous. Enormous. We are fielding calls from constituents. We are trying to get information out even if it’s to say we don’t know what exactly is going to be in the package or how we’re going to deal with this. But I think that anxiety is real because not only are people dealing with the health anxiety of not knowing and you heard about asymptomatic transmission. Everybody has to assume we’ve got this thing, but they’re also dealing with how do I take care of my mother? How do I take care of my kids? How do I pay my mortgage?

Your kids are not in school and your mother may be in a nursing home, which scares the hell out of you also.

Exactly. Exactly. You literally have a whole series of bills coming due. Some people may have paid through March, but we’re starting to hear a lot because we’re coming on the end of March and there’s a lot of people who have already lost their jobs.

All right. So what we’re talking about is the interconnectedness of everything.

That’s right.

Abdul, do you want to jump in or who was-

I certainly agree with Dr. Mukherjee’s and representative Jayapal’s points about the structural realities that force people into a moment where this pandemic has literally exploited all of their vulnerabilities. But I want to speak to just some of the practical things that people can do. Social distancing doesn’t have to be social isolation. I do think that it’s easy in this moment where we’re staring down the barrel at something we don’t know that’s causing us a tremendous amount of anxiety, trying to figure out how to make ends meet, to feel very alone. I think that it’s really, really critical that folks reach outs to each other and talk to each other about the challenges that they face. We’re social beings and we crave human contact and this ain’t it, right?

It’s great to be able to see your faces, but it’s not the same. So being able to just reach out and have a really honest, open conversation about how you feel, about your frustrations, about your anxieties. If you’re not feeling you need it, then somebody else does. You should be reaching out to that person in your social circle as well. And then the last point I’ll make is that for those of us who are lucky enough and blessed enough to be quarantining with family. For me, I just know that I always try and find the silver lining in every cloud. I’ve spent more days with my little two year old in the last several…

Dr. Abdul El-Sayed: (01:00:03)
I’ve spent more days with my little two-year-old in the last several weeks than I have in a long time because most of the time I’m on a plane but that’s not happening right now. And so being able to say, look, my life has been turned upside down by this thing as all of ours have. But I’m lucky enough to be healthy. I’m here with somebody I love and the rest of my life doesn’t usually give me an opportunity to spend time with this person. Let me do that now because I have that time. And then I think for a lot of folks it’s forcing us to actually rethink, like what are the things that are really important? I spent all this time doing all these other things and now I don’t really need them in my life and where should I be centered?

And so if that’s an opportunity for you, then maybe it is that small silver lining in what is a very dark and very scary cloud. And so reach out to folks, spend time with the folks that are there with you and try and build connections even as we socially distance, it doesn’t mean that we should socially isolate.

Bernie Sanders: (01:00:51)
And I would add to that, while sitting home and socially disconnected to others, we might want to think about how we got to where we are and why for example, there is so much anxiety, economic anxiety, why don’t we have healthcare as a human right? Think of what that would mean. Right now, the bill that will probably be passed tomorrow will guarantee coverage for testing, that’s great. And yet what happens if I have the illness and I end up in the hospital? That may cost me thousands of dollars. What happens if I don’t have the money, what happens if I’m uninsured? So the other question that we have to ask ourselves is, I worry very much and it hasn’t been enough discussion about this, is half of the people in this country are living paycheck to paycheck. And paychecks are stopping, what’s going to happen to those people? What do you do if you don’t have a paycheck to feed your family?

Now, hopefully the money from the government will get out soon enough, but needless to say, the anxiety level is terribly high. All right, we’ve got another question. This comes from Kimberly Mims and she writes, ” Is there a reason to worry about a second or third wave of this virus? If so, what could we expect?” Who wants to take a shot at that one?

Dr. Rishi Desai: (01:02:10)
I think I can address that. So one of the things that we’ve talked about with COVID-19 is the fact that it started from a coronavirus. From that [inaudible 01:02:23] relationship it had to MERS and SARS, which were also coronaviruses. These things are going to keep coming. Humanity is going to keep basing new pandemics, new issues like this that we’re going to have to deal with. The existential threat of course, being climate change itself. And so I think as we recognize what’s working and what’s not, the invariable truth is that we’re a very global society and we can’t simply just isolate ourselves. Even at an individual level, isolate our own problems. One are the things that I think is quite beautiful about these issues is that there are solutions that are kind of emerging that you wouldn’t have even thought would have been discussed a few months ago.

You just mentioned the fact that universal testing is going to be covered. I can’t think of an immediate example of another universal test that’s covered for everyone, no questions asked. But clearly people see the value here and maybe this is the beginning point for kind of expanding that out and scaling that out. There is a proposition you mentioned about universal basic income, that six months ago would have been considered quite progressive and maybe out there, but now we’re doing it, both sides recognize the need. I think that there are moments like this and there will continue to be moments probably more and more of it, where we recognize that these solutions are not so far fetched, but that actually they’re very necessary and the faster we implement, the better off we are as a society.

On the point of anxiety, I just want to add on the last question about unemployment. One of the beautiful things that I see, one of the silver linings that I think is awesome, is that you see the business community, the education community starting to step up in ways that they didn’t have to. Companies are making ventilators when six months ago they were making cars, they didn’t have to do that. And the fact that they’re stepping up is impressive. And one thing that we’ve had inbound is number of universities have reached out and said, hey, can we help you raise the line as I was saying, can we create a place where people can get employed? So four months on, they’re not waiting for kind of what’s my next paycheck, but they can start getting a career in the healthcare specialties where we know they need to be.

All right, let me jump in and get back to the question. “Is there a reason to worry about a second or third wave of this virus?” We have heard that in the fall, who wants to jump in on that one?

I just recently interviewed one of the lead infectious disease modelers at Yale for my podcast, it’s called America Dissected. But we’re actually focusing a lot on these questions. There are a couple of scenarios that we are staring down the barrel at. There’s one that says that we do this very, very well and we’re all able to self isolate. We’re able to freeze this thing in place and we see a steady decline in the curve and it doesn’t come back. There’s another scenario that says that we find ourselves on that decline and then we start to loosen the social distancing and then we see an upswing again. And then there’s another scenario that says, well, we know that these infectious diseases are less common in the summer. It’s plausible that we see a decline because of the summer months and then it comes back roaring in the fall and in the winter, which is what happened with the 1918 flu pandemic.

We actually don’t know. There are competing outcomes from different models that model out all of these different scenarios. And different groups of highly educated experts making a set of very plausible assumptions that predict any of these plausible outcomes. The real point though is that the choice that we have in front of us is whether or not we are willing to invest in social distancing right now so that we can maximize the potential for the outcome where there is no second wave and then we can freeze this thing in its tracks. We don’t know what the future looks like. We have a number of different models that predict very different outcomes. But the question that we, we can deal with right now is what we choose to do in this moment to try and get the best possible outcome. And so my frustration sometimes is that we predict, well, this is going to go on for three months or five months or 18 months, ah, what are we going to do? We’re all screwed anyway. That’s not the attitude.

The attitude is, we have the potential to reduce the impact of this thing now, we better take that potential. We all better socially distance for right now, do our best and then if there’s a scenario where it comes back, then we’ll deal with it then, but right now we all have a choice about what we’re going to do tomorrow and we all better make the right choice because all of us are in this boat together.

All right, Abdul, you referenced the Spanish flu of 1918, is my recollection correct that during the summer it receded and came back full blown in the fall. Why is that? Explain to non-experts why viruses recede in warm and humid weather?

You know, I wish there was a simple answer and the honest answer is we have a lot of hypotheses but we actually don’t know for sure. One reason is that when the amount of time that a virus will survive in an air droplet or on a surface is just lower when it’s warm and humid. The other answer is that human behavior is very different when it’s warm and humid and the amount of time that we spend cooped up in small places is lower. And there are other plausible arguments about why. It’s also that every one virus that has its moment in the fall and winter, the cumulative impact of all of those viruses together reduces your body’s capacity to fight any of them in all [inaudible 01:08:14] So it’s all of those three answers plus others together.

But what happened in 1918 at least is we know that, because society’s capacity to even know the global experience was limited, right? We couldn’t send information across the world as quickly as we did back then. Plus our ability to keep people alive was substantially lower. And so as people just kept living their life because there was no real concerted public health intervention like we’re doing right now, that it started to dissipate. But what did happen is actually the bulk of deaths happened after those summer months because it came back and full force in the fall. There are a lot of reasons to believe that that scenario is very different then what we’re facing right now in large part because we’re all working on trying to address this thing.

But we’re not sure. That’s the thing, we’re not really sure. What we are sure of is that we need to continue to socially distance that in so far as we can eliminate people communicating this virus to other people, that it will have a real impact on how long this lasts and how many people die that we should be doing all we can to prevent that.

Okay. We have a question that came in while we’re on the subject with transmission here. The question is, “How long can the virus be transmitted from touching certain objects or surfaces? Can it be transmitted on clothing, in hair, et cetera.” Who wants to take a shot at that?

I’ll try to answer that. So one way to divide up how things transmit is to think about porous and non-porous surfaces. So a non-porous surface is kind of a hard surface. So let’s say a cellphone, sink surface, doorknob, those are non-porous, kind of firm, hard surfaces. Porous surfaces are clothing, pillows, blankets, things like that. Generally speaking you’re looking at two things, not just how long does it survive but how long does it survive and then transmit. And typically with these studies are looking at how long it just survives and things do survive in the environment for considerable period of time. But that doesn’t necessarily mean they’re going to transmit at the end of that duration of time. There’s also one more factor, which is that over time the amount of virus is going to go down. So it’s dying over time and that’s called the inoculum.

So the inoculum you get is going to be a lot less three days out than if you just touched it on day one. So those were a couple of factors that you should think about when you’re hearing these studies of three days or 17 days was just reported today in the news. These numbers have to be [inaudible 01:10:56] with those kind of thoughts.

Okay. Let me throw out what I think will probably be the last question here. It’s almost getting back to how we began. This is from a Lee Law. “What symptoms should someone have to signal that they need to actually seek help from a doctor?” In other words, when you really need to go to a doctor. Who wants to take a shot of that one? [crosstalk 01:11:23]

Dr. Joia Mukherjee: (01:11:25)
I think we do have this limited testing but I don’t think we should as medical professionals only be looking at the scarcity that our political choices let us choose. So I would say, if you are sick with symptoms of a fever, aches and pains, coughing, you should contact a doctor. You shouldn’t necessarily go to a facility. But there are many primary care doctors now that are doing telemedicine consults. We are in a changing environment where tests are more rapidly available. Don’t wait till you’re short of breath. There was a tragic story from Washington of a 30-year-old woman who was found dead in her home with a four-year-old child. Don’t wait and it’s not just the elderly, this virus is [inaudible 01:12:16] many young people. So contact someone and see if you can at least get advice on the phone from your physician or a nurse or a telemedicine consult.

All right on that note, let me thank all of our panelists. You were great and we appreciate your being with us this evening. Let me thank all of the folks out there who are viewing the program and we will see you all soon. Everybody stay healthy and listen to what the doctors had to say. Okay, thank you all, good night.

Bernie Sanders Town Hall Coronavirus Transcript with Public Health Experts

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