Coronavirus (COVID-19): Press Conference with Aaron Bernstein, 05/01/20

You’re listening to a press conference from the Harvard T.H. Chan School of Public Health with Aaron Bernstein, interim director of the Center for Climate, Health, and the Global Environment (Harvard C-CHANGE), a pediatrician at Boston Children’s Hospital, and an assistant professor of pediatrics at Harvard Medical School. This call was recorded at 11:30 am Eastern Time on Friday, May 1.

Previous press conferences are linked at the bottom of this transcript.


AARON BERNSTEIN: Thanks everyone for gathering today. I want to talk a little bit about why pandemic prevention measures are obviously so critical right now, but go well beyond the scope of what was being commonly discussed in terms of testing and health care facility readiness, as critical as those pieces are. And to do that, I want to set the stage by pointing out a few facts.

Which is that right now in the United States we spend about $3.6 trillion to take care of people after we’re sick. That’s one in five of all dollars spent the United States. That’s overwhelmingly because of preventable conditions that stem from unhealthy diets, smoking cigarettes, pollution, things that we know we could address and have addressed in many ways successfully. While the American population has gotten less healthy in recent years, we’ve seen the growth of health disparities. So, particularly people of color have less access to care, they often suffer for higher burdens of diseases like heart disease.

And at the same time, we’ve seen hospitals, particularly serving rural communities, failing. So, 2019 had one of the highest rates of hospital closures in the country’s history and this year, 2020, was forecast to have yet a higher pace and that was before Half the hospitals in those counties have been losing money historically, and about 500 of those hospitals are the only hospitals in those counties.

And so, there’s a real risk that the access to care, particularly for rural Americans is going to be compromised even faster than it would have been before coronavirus happened.

So, all this is going on with the health and healthcare of the United States, it turns out that humanity is doing a number on nature. We’ve been acting as though we could reorganize all of the pieces of life on Earth as if we were playing a game of chess for them. And in our game of chess, we have knocked out all of nature’s pieces, or I should say we have knocked out many of nature’s pieces, at a pace that’s unprecedented in human history. And what’s been left standing is a very angry queen. And the emergence of COVID is what nature is trying to tell us about how we have mismanaged nature and this fire has been unleashed on the world, and particularly our country which has a health care system that has been put against the ropes already, a population that is not as healthy as it was years ago, and that in all of these cases, the actions we need to do, be it address the obesity epidemic, address the diseases caused for pollution, are a set of solutions that are things we should be doing for, you know, preventing pandemics, preventing the spread of pandemics.

We can talk about the air pollution contribution to this pandemic. We can talk about the reality that pre-existing medical conditions, for which I mentioned we’re spending $3.6 trillion on healthcare, a large share of that is on conditions that are preventable that those solutions in fact confer other benefits like preventing climate change, like preventing the origins of pandemics themselves. And I think there’s some very important questions to ask right now about the money that the federal government and states are pumping into our economies that could be used to put us on a path that would in fact not only address the health problems that are driving a massive expenditure into the country but could also get at the health disparities that not only are immoral, but are really dangerous for everybody as COVID makes so clear. We know that people who are poor in this country and around the world are more at risk for getting exposed to the virus and often because of poverty are more at risk of getting sicker and dying from it, either because they may be unable to access care, afford care, or host of other factors.

And so, I think this moment really affords us an opportunity to do some stuff that we should be doing for the health of Americans anyway, and at the same time achieve some goals that many of us would like to see attained related to the nation’s greenhouse gas emissions. So, with that, I will stop and gladly take questions.

MODERATOR: Great. Thank you, Dr. Bernstein. Okay, looks like our first question. Please, go ahead.

Q: Yeah. Actually, I have quite a specific question on the correlation between air pollution and COVID-19 mortality, which is based on a recent study that was conducted and published by a team of researchers at the Harvard Health School, I see. I think the leader of the research was Rachel Nethery.  So basically, they said that exposure to a PM 2.5 increases the death rate of COVID-19 by 15% per each microgram net cubic meter of a PM 2.5. So, I was wondering how many of the 60,000 official recorded deaths basically can be attributed to exposure to PM2.5 considering that the study said that the death rate increases by 15% for each one microgram net cubic meter.

It’s very specific question. But, as you said, it’s very important to tackle the issues together. So, I guess that exposure to pollution played a pretty big role in the deaths. So, I think will be important to connect.

AARON BERNSTEIN: That’s an excellent question. I don’t know the answer to it. I wasn’t directly involved in that research and the reason I don’t know is because, as you point out, the difference that they found was per unit increase of air pollution, but that increase wasn’t in this year, it was the past 10 to 15 years of exposure.

And so, the rate is per population. And so, you have to look at the various counties and go back, which is doable and they may be in fact doing that, but I don’t have the direct answer to your question right now.

Q: Okay, well thank you.

MODERATOR: Next question.

Q: Hi, Dr. Bernstein. I’m wondering, given that you’re a pediatrician at Children’s, are you seeing any, or do you know – I don’t know if you if you work in the ER there. Do you know whether the ER there and the COVID cases that are coming in are fewer than might be expected by the experience at non-Children’s hospitals? I mean, is there a signal of COVID’s decreased impact on children being seen at Children’s Hospital?

AARON BERNSTEIN: So, we’ve seen, consistent with the experience around the world, that children are fortunately less affected. The rates of severe infection in children are lower by a long shot than in adults. Now that’s not to say that certain children aren’t particularly at-risk – children under a year, children with chronic medical conditions. But yes, I think it is clear that children are less affected and less hospitalized.

Q: And to kind of merge with the previous questioner’s question about air pollution, is there any way to tell – and I don’t know if this has been looked at – whether the children that you are seeing from areas that might have more pollution? There is some discussion whether Chelsea is a place that has, you know, more, more air pollution and people there may be more susceptible.

AARON BERNSTEIN: Sure. We don’t – because the numbers are relatively low for hospitalization, I don’t know that anyone has asked that question specifically, but my hunch is that would be hard to tease out given the numbers of children affected.

Q: Very good, thank you.

MODERATOR: Next question.

Q: So, this is really a tricky question and I don’t think there is an answer, but anyway, I would like to try to challenge on this question. So, some research or some study said that the death rate, meaning the percentage of infected people that died due to COVID-19 is a more or less high, some people said it a far higher than the death rate of normal flu, some others say it’s lower? Where do you where we can stack the box? End of question [laughs].

AARON BERNSTEIN: I think those questions come from the reality that we haven’t nearly tested enough people to know the answer. And, you know, in order to get a decent assessment of how many people are dying, you have to really understand how many people are infected and certainly in this country we haven’t come close to doing that.

But I think the, you know, to your point, Stefano, I think regardless of whether this is the United States or overseas, you know, healthcare systems have been strained immensely by this virus. And you know we have flu already. We know we’re going to have a flu season and a bad flu season that has already put strains on our healthcare systems. And so, we spend a lot of time talking about right now, you know, how many ventilators are we going to need, how many, you know, doses of certain drugs, we might need. But the truth is that we see viruses like coronavirus come from animals into people two times every year. And that isn’t by chance. That’s because of what I said – we’re going into nature, taking animals out of nature, and making close contact with them. And so, we’re playing a game of roulette. And if we now have coronavirus season on top of flu season, and the United States and a health care system, as I mentioned that has been put on the ropes through changes and funding schemes and insurance schemes, it’s not going to matter who pays for health care. We’re already paying $3.6 trillion healthcare.

So, my hope is that one of the responses of the healthcare community to this crisis is to call upon elected leaders to say that we actually do have to do these primary prevention actions that I was talking about. It is simply inadequate to talk about the number of ventilators, the number of tests as a way to deal with this kind of problem. If we continue to have emerging infections, as we have had in recent years, HIV is an emerging infection from an animal, SARS, pandemic influenza in 2009. We are setting ourselves up for an unmitigated mess and at the same time, we know that the actions that prevent these things are not only good at preventing pandemics, they’re going to prevent air pollution, they’re going to reduce obesity, they’re going to address mental health problems, and perhaps most importantly, they’re going to address climate change, which is a huge health problem,

And, you know, none of you have asked about this, so I’ll tell you, you know, we’re now concerned that they’re going to be waves of coronavirus infections, right, so that even with some social distancing in place, we’re going to see recurrent episodes of cases of coronavirus. Well, in the United States, we’re coming up on summer and last year, 2019, half of Americans were subject to heat dangerous enough to land them in a hospital. There was heat warnings for half of Americans last summer, it was the hottest summer on record. That is also not by chance. And we know that when it’s hot out, rates of visitation to emergency rooms for all kinds of people who have chronic and, in many cases, preventable medical conditions, go up.

So, we can see what’s coming, just as we could have seen this emerging disease coming because we have seen this before. We can see for health care in this country a crucible of emerging infectious diseases, increasing burdens of disease from climate change. And we also can see a better future, a future in which we reduce the pollution that’s contributing to mortality from coronavirus, that’s giving one in five children this country asthma – that’s the best evidence we have on the role of fossil fuels and their contribution to children with asthma in this country – that is leading to the early deaths of some hundred to 200,000 Americans every year and millions of people around the world.

And we can prevent those things. We can do that. And that’s why the investments right now are so critical, because those are dollars that can either be spent on, you know, advanced renewable energy investments, to address the immense amounts of energy loss in our buildings. So, with the American Reinvestment Act from the Great Recession, there was about $600 million that was specifically targeting retrofits to buildings, about a third of American households are facing difficulty paying their energy bills right now. Those are overwhelmingly in rural communities in this country. We can address that. We can lower their energy bills. We can reduce the air pollution that comes from fossil fuel-based energy systems and houses that’s making people sick and making them at risk for coronavirus. These are things we can do right now with the stimulus monies that are being put on the table and really will make people’s health better. They’ll address inequities, their risk for pandemics spread and death, and a whole host of other health outcomes and will provide a livable planet for children.

MODERATOR: Did you have a follow up?

Q: So, it’s very interesting approach. I was just wondering from a policy perspective, how you would suggest political leaders to translate your very cross-disciplinary, even quite philosophical concept into concrete measures that can be quantified based on short term, or medium term, or long-term objectives? So the political leaders can sell it to their voters: okay, this is the problem.

AARON BERNSTEIN: I don’t think there’s anything nonconcrete about $600 million being spent to weatherize homes. I don’t think there’s any – I mean, we did an analysis as another example that if you’re going to invest in renewable energy like wind and solar in the United States, where would you cited to effective the greatest reduction in health burden, we found that there are some $1.2 trillion that could be saved and essentially lives lost for installing 3000 megawatts of wind in the upper Midwest.

We know that in many urban environments in the country, one of the greatest sources of air pollution is from vehicular exhaust. Well, right now, we are rolling back standards on vehicles for their auto emissions. That’s going to make people sicker. And of course, we’re trying to at the same time accelerate adoption of electric vehicles. And so, we know that pollution in cities from vehicles is a big problem. The solution to that cannot be pigeonholed because if those cars are powered by coal plants, we’re going to get potentially more pollution, which again speaks to the necessity of continuing the progress that’s made under the Clean Air Act, which, you know, has been very clear.

And also, frankly, putting a value on carbon dioxide emissions because, short of that, we’re not going to necessarily get to the health gains that we need.

But, you know, if you want other examples of where investments can be made in the United States, we have tremendous offshore wind potential off the eastern seaboard in particular. We have tremendous wind in the central part of the country. We have tremendous solar in the southwest. And for many of these energy resources there either bureaucratic hurdles to getting them completed or there’s a lack in infrastructure to transmit the energy from, for example, the Great Plains to population centers elsewhere or the solar resources in the southwest to populations on the West Coast. So, you can pick any number of areas where the stimulus money could go and they all confer great advantages.

Again, there’s immediate benefits to health, our analysis in the energy work showed that the reason that the upper Midwest, installing wind in the upper Midwest and solar and wind in the, sort of, Great Lakes region is so beneficial is because that displaces the most coal from the grid and coal is the most polluting source of energy. So, it does really matter where you do these things. And so, we tried to give policymakers some insight into where these investments would in fact provide the greatest health benefits right now.

MODERATOR: Next question.

Q: Hi there. Thanks so much for doing this. I appreciate it. I have two questions. One, I was wondering if you could talk a little bit about the impact of weather on COVID. I know this is a topic that has been discussed a lot at length, but I still feel like there’s a lot of misinformation out there on how seasons and weather can really impact respiratory illness, especially this. And then second, I was wondering if you could elaborate a little more when you talked about heat waves and the, you know, uptick we see an ER visits. Is it maybe the challenge is that this could add to keeping the numbers low, is it that we are going to overburden the healthcare system? Is it exposing, you know, more people to the virus or increasing their risk by exposure? Can you talk a little bit about that also?

AARON BERNSTEIN: Sure. So, I think you’re right in there’s been a lot of the messaging around whether in COVID everything from ‘we’re going to have a real reduction in cases in as temperatures warm’ to, you know, maybe no effect. And I think the science there is not as clear as it needs to be. And I don’t think it can be because although we have other coronaviruses to draw influence from, we don’t have experience with this coronavirus. The history of coronavirus does show that they tend to be seasonal and that there’s likely going to be a slowing based on that. If this current coronavirus like other coronaviruses, warmer temperatures and more humid weather may slow it down.

But there’s some research to suggest that even at saw rates, it’s still going to be capable of exponential transmission So, you know, slower, yes. But is that going to make social distancing obsolete? I think we don’t know yet and so again, we need to be mindful – and I think this is to the second question you raised – of where we’re at going into summer. We have health care workers around this country and around the world who’ve been working in extraordinary circumstances and some of the most densely populated parts of cities in the world. And if it turns out that this coronavirus is not particularly slowed down by hot weather and we might notice that there have been bad outbreaks in places like Singapore, in places in the South like Louisiana, there’s some reason to believe that even if it gets warmer this virus could still set us back. That we need to acknowledge at the same time that we know with summer it’s going to be hotter and we know, particularly for people who are older that hot weather increases risk for hospitalization and death. And there’s an abundance of research showing that.

So, I think, you know, to your second question, yes, in the context of thinking about loosening restrictions on social distancing, on where people can travel, on all these things, we have to be mindful that heat, which is becoming increasingly prevalent in, you know, cooler climates historically cooler climates in particular, that healthcare systems might have an additional strain. and this is to the point I raised earlier, which is we already have influenza season. If we now have influenza and coronavirus season, are we going to be able to tolerate yet another emerging infection that could come as we’ve seen them coming at an increasing pace? And if we’re now forcing the climate to a place where it’s hotter out and that’s making people sick in the summer, again, we can – the bottom line is we can assign probabilities to these events, but that’s sort of beside the point. We need to be reducing use of fossil fuels. We need to be increasing people’s access to, you know, more plant-based diets. We need to give people more access to active transportation for the sake of the health of the people alive right now.

And oh, by the way, those actions are going to be enormously important to addressing climate change, they’re going to be enormously important to building resilience in the population for when pandemics to emerge, and so, I just think there’s just one on top of another compelling reason to take these actions for the health of people, and particularly those people whose health is most vulnerable right now.

Q: Wonderful, thank you so much.

MODERATOR: I guess I had a couple of questions. One that’s been coming up a lot in my inbox is with a lockdowns, a lot fewer people are driving, a lot fewer people are flying? Have you seen positive effects of the lockdowns on greenhouse gas production?

AARON BERNSTEIN: So, we’ve seen in every country that’s a major emitter reductions and air pollution 20 to 30% of many forms of air pollution in some cases, and that, you know, includes things like carbon dioxide in the case of greenhouse gas emissions. Though, we have to remember that with carbon dioxide, it doesn’t just come out of tailpipes and go into the atmosphere, it can be absorbed by plants. It goes into the ocean. There are sinks for carbon dioxide in the air system. And we’ve been pumping so much carbon dioxide and other greenhouse gas in the atmosphere is that even with the slowdown that we’ve seen in the past three months, it’s likely we may not even see a blip on the radar of carbon emissions in the world. If we do see a blip, it will be will be will only be that unless we do, of course, the other things we need to do to reduce those submissions in the first place. So, from a greenhouse gas standpoint, this event is a non-entity.

And you know, I think the other side of that question, which is, when are people better off because the air is cleaner. And the answer is yes. But remember that the study from Rachel Nethery and Xiao Wu and Francesca Domenici at the Chan School. The air pollution exposures that they saw were affecting the likelihood of people dying were not the air that people were breathing in the past three months. It was the air quality of the places that people are living over the past 15 years, which suggests that it’s the damage to the long over time from this air pollution that makes us more vulnerable when respiratory infection hits, and by the way, that’s not unique to coronavirus that’s true seasonal influenza. So again, if we, you know, as you all know in flu season 10s of thousands of people every year die and some percentage of those people are dying because they’ve been breathing polluted air.

So again, we have real reasons to reduce air pollution which I should point out, for the first time in decades in this country, air pollution has been getting worse. And that is a real cause for concern, because it’s not just bad for our health, it is bad for our economy. And as we have ample evidence that this air pollution affects our ability to think, it makes people miss work because they’re sick,

and it’s at a time when you know with coronavirus, air pollution may be having a, you know, an amplified effect on the health of people in the country.

MODERATOR:  Thank you. And I had another question. So we’ve been talking about heat in summer and there have been some reports that or hopes that the virus would subside during the summer. But we also know that, as you were saying, that there are more problems with people in the heat and heat also tends to increase air pollution certain times, certain days, when the air quality can be very low. Do you anticipate that would also affect people who have asthma and that the air quality that’s decreased would also makes them more vulnerable to COVID-19?

AARON BERNSTEIN: There’s a study that’s just come out, which was quite surprising out of California is showing that ozone pollution, which is the kind of pollution that you’re referring to, which is really cooked into existence by temperature, higher temperatures, that ozone pollution surprisingly has gone up. And that is surprising because in order to make ozone, you need a cocktail of chemicals that come primarily in most places out of the tailpipes of cars and trucks and the smokestacks of power plants.

And what was found was that some of the emissions from tailpipes in cars include nitric oxide and nitric oxide actually scavenges ozone. So, the absence of vehicular exhaust has actually lead to less ozone scavenging, so the nitric oxide is not pulling the ozone out of the air, and there are enough other chemicals around to produce ozone that levels have gone up perhaps 10%. So, if we continue to have, you know, you know, this is, this is one of these situations where, you know, you don’t need to have a pandemic to show that fossil fuels have, you know, know we can really – you know, the effects of the health benefits of reducing fossil fuels, that’s not a good reason to have a pandemic. It’s not a good reason to have a pandemic to show that, you know, car exhaust may be buffering ozone pollution. I think that what that kind of research makes clear to me is that we have air pollution concerns and ozone.

To be clear, is a major problem for people who have asthma, children who have asthma, adults who have asthma or chronic lung diseases we have concerns now whether people are driving or whether people are not driving that the ozone problem is going to be with us unless we tackle the root cause, which is again burning fossil fuels in many cities around the world.

MODERATOR: Okay, does anybody else have a question?

Q: Another kind of philosophical question. So, I am wondering – I don’t know if you can make such a calculation now – I am wondering if they combine number of deaths due to all kinds of data sources like air pollution, heat waves, and flu, whatsoever, if they overweigh or at least equate to the death officially contributed to COVID-19? So, whether they equate to this count or whether they overweigh it. Is the death count of COVID-19 so dramatic, has such an impact on our public opinion on governments and the media because there is an exceptional amount of people that are dying in a very short time or because the death count is really much higher than any death count that can be attributed to any sort of natural death?  So, I mean, if the newspaper counts throughout the year all the victims of flu, of air pollution, of heat waves, if they count all those victims, would such a death count have the that have an emotional impact on people or is it a disconnect that COVID-19 which [INAUDIBLE] which creates a kind of mystery which adds up to the pathos and the emotional side of things? I hope my question was clear enough if it got a bit messed up.  

AARON BERNSTEIN: Now, that’s okay. To find out, it’s actually pretty easy. So, air pollution, you don’t have to go beyond air pollution. Air pollution, outdoor air pollution, and fossil fuels in particular, the best evidence is that they’re probably killing four to 6 million people every year in the world, if not more. And in the United States, there are probably 100,000 to 200,000 people dying from air pollution and that doesn’t include the harms, for instance, to the children I care for. So, it ignores children. So, we know that air pollution, particulate matter pollution from fossil fuels, leads to worse outcomes from pregnancies. We know it damages children’s brains. We know that it is likely contributing to type two diabetes.

And so even air pollution from fossil fuels on that basis alone. It’s a far bigger annual problem United States around the world and in terms of its effects on health, then COVID I think the difference with COVID is, of course, that it’s one new to its immediately, causing us to rearrange our lives in ways that are not good and having a very sudden shock on the economy. But, you know, looked at in comparison, it is quite likely that, you know, the economic effects of air pollution in the world, the health effects of air pollution on the world are greater than COVID. It’s just that they’re spaced out over time. And of course, they’re not creating new diseases, there can this air pollution is contributing diseases that are caused by other things too. So, you know, there’s a real challenge in in in making clear the connections between air pollution and health because they’re not, unlike coronavirus, immediately clear all the time.

Q: Okay, thank you.

MODERATOR: Alright. I think that’s our last question. Dr. Bernstein, do you have any final words before we end the call?

AARON BERNSTEIN: No, no, I’m good, thanks.

This concludes the May 1 press conference.

Marc Lipsitch, professor of epidemiology and director of the Center for Communicable Disease Dynamics (April 30, 2020)

Barry Bloom, professor of immunology and infectious diseases and former dean of the school, and Bill Hanage, associate professor of epidemiology (April 29, 2020)

Michael Mina, assistant professor of epidemiology (April 28, 2020)