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Former Centers For Medicare And Medicaid Administrator On Our Future With COVID-19


We are at least four months into the coronavirus pandemic here in the United States, and things are getting worse - record infections; hospitals overwhelmed; shortages of tests, masks and other personal protective equipment - a constellation of competing and uncoordinated responses by local and state governments. And our next guest says things could get worse in the fall. Andy Slavitt worked for the Obama administration in public health, and he has been an outspoken critic of the U.S. response to this pandemic. And he joins us now.



GARCIA-NAVARRO: It is hard to feel like this is not a runaway train, but you say that the one way to salvage September is testing. What do we need to see?

SLAVITT: Well, it's very challenging without a coordinated national response. I think you'll be encouraged if you looked around the world at countries as diverse as Greece and the Czech Republic and Vietnam to say that with a national strategy, which includes testing and masks and contact tracing, you can keep this virus very, very low to a very small number of cases. And that allows people to get back to work and largely go to school. But without that response, you can't just expect people to be able to get back to work and school without feeling that it is a threat to their health.

GARCIA-NAVARRO: So we're seeing, though, this testing capacity here in the United States getting worse and not better in many parts of the country. Why is this happening? I mean, is it only the federal response that's lacking, or is there something else that's standing in the way of that?

SLAVITT: Well, it's a function of two things. It's a function of letting cases grow out of hand so that the testing companies can't deal with the backlog they have, and it's also a function of not having a coordinated national strategy. China was able to test 11 million people in one weekend. We are still on a path where we're only able to do five, six hundred thousand tests a day.

So what we haven't done is we haven't called on the great university labs in this country to get them certified to be able to conduct much more testing. And we haven't been able to innovate fast enough to catch up with the virus. So we are still constantly chasing something that's growing exponentially, and that's hard.

GARCIA-NAVARRO: Let's look at the future - first of all, the fall. In some places, kids might be in school, and it will be flu season. What do you predict?

SLAVITT: The fall's going to be very complicated. I think we're dealing right now with the crisis in the parts of the country where people have to be indoors more because of the heat and humidity - so Phoenix, Charlotte, Miami, Los Angeles, Houston. But if the fall comes, the virus will be more challenging in places in the North where people have to be indoors because of the cold. And at the same time, people are going to be having flu symptoms, which is going to be very confusing.

And we're going to see, I think, a push, probably driven somewhat by the election season, for more normalcy, meaning people going to church, people going to school, people getting in crowds, people getting in elevators. And all of those things together, which I think under normal circumstances would be challenging, could be even more so because we won't have any visibility into where and how it's happening.

GARCIA-NAVARRO: Do you think Americans are perhaps becoming accustomed to this amount of infections and 130,000-plus deaths? Do you think that they're simply feeling that this is somehow acceptable? You know, people aren't wearing masks. They're going out and taking risks that public health officials say they shouldn't take.

SLAVITT: I think the moods have shifted around in this country a bit. I think some people are feeling quite defeated because they don't see the leadership or the support that they need. Secondly, I think there is somewhat of a failure of imagination on many of our parts because, you know, we hear about these cases being in nursing homes or in Black and brown communities or people with illnesses. And we may feel, oh, well, that's not me; I feel safe. And maybe there haven't been enough cameras inside hospitals showing what's really going on and showing the horror.

I talked the other day to Governor Gretchen Whitmer on my podcast, and she said she's lost three family members to coronavirus. And she described the experience the following way. She said, they check into the hospital, and you never see them again. And she said there's nothing really like that, and it's very hard to explain to people who haven't gone through it. And we have much of the country that maybe has not gone through it yet, but maybe they do know people who've lost their jobs or who've had to close their restaurant. And that's what coronavirus means to them today. So it's a very uneven understanding.

GARCIA-NAVARRO: I want to talk about perhaps some good news, if there is any. One of the threads you had on Twitter this past week was about what the world will look like in three years. You spoke to three scientists about that. And the good news is there will be some kind of vaccine or several kinds of vaccines.

SLAVITT: Yes. I think the thing that people don't see that should make them very encouraged is the pace at which science is tackling this virus. There's a lot we still don't know. But I've never heard more scientists, including skeptical ones, quite so optimistic that we will have not just vaccines, but also really good therapies and medications so that the disease is less deadly.

Now, the challenging news is it doesn't mean quite what people think it means when they hear about vaccines. The expectation people should have is that a vaccine will work on some percentage of the population maybe more like an influenza vaccine that works on, let's say, 40- to 50% of the population. And it may work to reduce symptoms. It may reduce to get rid of symptoms. But we should consider it part of an arsenal of things, including things like convalescent plasma, that over time are going to make this disease harder to spread and less deadly. But it won't happen overnight. It's going to be a gradual set of changes. And I think that will include people continuing to adapt their habits so that the virus is less likely to spread.

GARCIA-NAVARRO: That's Andy Slavitt, the former acting administrator of the Centers for Medicare and Medicaid Services.

Thank you very much.

SLAVITT: Thank you. Transcript provided by NPR, Copyright NPR.

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