You’re listening to a press conference from the Harvard T.H. Chan School of Public Health with Leonard Marcus, director of the Program for Health Care Negotiation and Conflict Resolution and co-director of the National Preparedness Leadership Initiative. This call was recorded at 11:30 am Eastern Time on Friday, April 10.
Previous press conferences are linked at the bottom of this transcript.
LEONARD MARCUS: Nice to meet all of you and thank you for the work you’re doing. We really depend, we as a country, depend on your efforts to provide public information and accurate public information to people who are at home and trying to figure out what’s going on. So, thank you. And if I can be of help to you in that effort, it’s a pleasure to be with you.
So, I co-direct the National Preparedness Leadership Initiative. The federal government came to Harvard shortly after 9/11 – David Gergen who’s at the Center for Public Leadership at the Kennedy School and me – and asked whether Harvard would invest its efforts in leadership for Homeland Security preparedness and response. We said yes.
And one of the unique activities that we engage with is that we embed as best as possible with leaders of responses and have been doing so over the years. So, way back when, in Hurricane Katrina, we embedded with Mike Brown – remember, “Brownie, you’re doing a heck of a job”? – was there when he was leading, when he was relieved of duties by the Secretary of the Department of Homeland Security, Michael Chertoff, and have since then been alongside with Admiral Thad Allen during the Gulf Oil Spill, with Dr. Richard Besser at the CDC during H1N1, and have done so with Secret Service through crises, Transportation Security Administration, FEMA and other agencies.
And our goal is to learn and understand what crisis leaders are experiencing at a time like this. We then teach that as part of our NPLI curriculum. So, well over 1000 people have been through that curriculum. They’re in senior positions, leading throughout the country at the federal, state, and local level and corporations and humanitarian organizations.
And we stay in touch with those people. They call upon us. We meet with them every week, those that are able to get off for a call with us. And so, we’re continuing to study what’s going on.
The situation right now in this country is that we’re in a race. And the race is the numbers of cases are going up and are we going to be able to get hospitals, our healthcare system, our testing, our capacity to deal with the large numbers of deaths – are we able to create the system so that it meets just in the nick of time, so we’re able to get ventilators to hospitals, so that when a clinician takes that last ventilator off, a new ventilator will be put on the shelf, so that we don’t get into a situation where clinicians have to make a choice of who’s going to get the ventilator.
And we’re in a race with personal protective equipment and with masks. And we’re having varying success with that race. In part, the public distancing has certainly flattened the curve, to some extent. We don’t know exactly how much but we hear Dr. Fauci and Dr. Birx at the White House saying that we were expecting 100 to 200,000 deaths. It might be lowered to 60,000 deaths because of the population’s adherence to physical distancing.
So, the race is to try and, as best as possible, reduce the demand on our healthcare systems, on our testing systems, to up the capacity to respond. Whether or not we win the race, we’ll only know in time as we look back at where we’re at right now.
But that’s the way – when we’re talking to leaders, it’s a way of understanding where we’re at right now and we hope that we’ll win the race.
You know, one thing that I think is happening across the country is a people are more and more willing to make supplies available, more willing to share ventilators. That’s going to be one aspect of solving this problem.
If an area is past their peak and they don’t require all the ventilators that they have on their shelves, that they’re willing to share with other areas that are just approaching their peak and that we’ve got capacities and systems in place to move around those vital resources, as the country experiences this pandemic. Different cities and different states are hitting their peaks at different times, so, if we’re real nimble and flexible as a country, hopefully we’ll be able to meet the needs in these different areas as we do reach these peaks.
So, that’s a very brief overview happy to take any questions. My area is mostly leadership and people and population preparedness. I can’t answer your questions about the virology, or the epidemiology. There are other people at our school were doing a marvelous job in studying and then reporting and providing information on that. So, happy to take any questions that are appropriately in my wheelhouse.
MODERATOR: All right. Thank you, Dr. Marcus, it looks like they have our first question.
Q: Good morning. Thanks so much for doing this. Really appreciate it. I was wondering if you could talk a little bit about which states are doing well during this. It seems like California, for instance, has had fewer cases than other places. And, kind of, what you think about what they’re doing and why it’s going better. Is it just luck or are they doing something better there?
LEONARD MARCUS: We always say it’s always a combination of smarts and luck. And one of the things that they’ve done, they were pretty early on in encouraging physical distancing. So, they’ve got a lot of good cooperation from the population. We don’t know yet exactly the impacts. We’re getting impressions, but certainly the impression in California is first, they were very quick to prepare and get their hospitals and other institutions in place and ready to go. They were very strict about their physical distancing – that message got out and people were willing to comply. So, they are certainly ahead of the curve in terms of flattening.
Washington State, they had the first cases in the United States. So, they got some early experience. What that did is those early cases create an enormous community spread, so they had the first series of deaths, but it got them very serious. So, they seem to be emerging on the other side of their peak to the extent that they’re willing to share some ventilators and other equipment with other states that are not, you know, that are still getting to their peak. So obviously, we all know the hotspots are in the New York area. Washington, Detroit and Louisiana are emerging hotspots.
And, you know, the one hotspot I think that is a great concern, which of course is all over the country, are the rural hotspots. So, we’re hearing us you know we’re hearing reports of significant numbers of people with a disease in food processing plants in rural areas. They don’t have the same capacity as the urban areas in terms of their healthcare systems. We know that healthcare systems have suffered over the last few years in rural areas.
So, those are places where we can have concern because as difficult as is the experience in New York, they have the infrastructure, the public health infrastructure, the healthcare system infrastructure, and the capacity to absorb the help that they’re receiving. It’s going to be a different story when we’re looking at some of these rural areas and time of course it’s going to tell how well prepared they are and what the impact will be in those states.
Q: Thank you very much.
MODERATOR: Okay, next question.
Q: Hey, thanks very much. I just actually kind of wanted to follow up on what you were talking about. I’m interested more in areas outside of big cities, like smaller towns and rural areas. And I know, you know, there are certain things that you can’t control in the short run that affects what kind of impact the pandemic might have there. You were talking about, maybe there’s a hospital enclosure, you know, there’s demographics like age and underlying health issues. But what are, like, in terms of what people at the local level, particularly local leaders can, – what are some of the things that they do that maybe work or maybe make things worse during crises? What will set a community that handles this well apart from other communities?
LEONARD MARCUS: First off, I’m thinking right now of Georgia, where there hasn’t been a consistent message coming from the state government, and there’s stories coming out of Georgia where there’s food processing plants – another story in the New York Times – food processing plants. I’ve heard also from within this leadership network of food processing out in Iowa, where they have continued to remain in business. People have shown up to work, who have contracted the disease. They spread the disease throughout the company.
I know that there have been efforts to provide support from the federal level to those states and to those companies, but as we’ve seen some of these states – Georgia, as an example, Iowa, the Dakotas – where there is a lot of food processing that’s being done, I think the question is whether you know what why those States didn’t get on board with the physical distancing, the stay at home orders for nonessential people.
That just didn’t happen in a number of those states, so that the population was not adhering to physical distancing as we saw in California or Washington State, some of the earlier states, and now the disease is running rampant. We see in some smaller communities – Columbus, Georgia is an example.
So, they’re going to have to be playing catch up. I think one of the questions, and we don’t have an answer to this question is – one of the questions will be what will be the impact on the food supply.
Because our food supply goes to urban areas, but it comes from rural areas and if those rural areas were not as careful about the physical distancing, were not as quick jumping into areas where there were cases, what’s that going to be in, first for those local areas and being able to cope with that. And second, what’s that going to mean nationally in terms of the food chain.
We still don’t know the answer. But those issues are beginning to rise now in the fourth week since the national – it’s been only four weeks since the national emergency was declared. So now at this point, this is what we’re beginning to see that.
Q: So, let’s say you’re a mayor or county commissioner in a state like Georgia or Iowa, one of the Dakotas, where there hasn’t been statewide policy or order. What are some things you can do at that level? I mean, or can you really make a difference or is it kind of like too big at that point?
LEONARD MARCUS: No – well, that’s a good question. First up their jurisdiction issue. So, what can a mayor do in terms of orders for stay at home? What is a mayor allowed to do in terms of closing business is done? That’s a tremendous power.
And we give elected officials those powers and it varies from state to state. So, governors have some of those powers, mayor’s or county commissioners have some of those powers, and presidents have powers. So, in a number of states that have been very slow to enact physical distancing, mayors have stepped up to the plate and did everything they could to encourage that physical distancing in their communities.
Ideally, in retrospect, I think what we will say is that it would have been better that we had an overall national strategy, so everyone was doing the same thing. In part because people travel from state to state. So, if one state or one area has been very careful, but people are coming in from areas that were not as careful, or coming in from areas where the disease is already much further along, then whatever you’re doing in the local is undermined by the movement of people. So, a uniform approach, in the end, probably would have done us a lot better as a country.
And those places, in particular those rural areas that were slow to get on board, are the ones that we’re now beginning to see are where cases are running rampant and the local communities don’t have all the infrastructure to cope with those cases.
Q: Thanks very much.
MODERATOR: Next question.
Q: So, you know, President Trump and the administration has sort of now been talking about some parts of the country are going to be able to open up by May 1.
At, you know, the rate that we’re going right now with, you know, trying to ramp up testing, do you think that we’re going to be able to, that the US is going to be able to expand the testing capacity enough that parts of the country can get open by early May?
LEONARD MARCUS: That’s a good question. And the answer of course is, we don’t know. So, the most honest answer is we don’t know yet exactly what the right steps are in opening up. And you can learn a lot from other places – Hong Kong has experience with this, Singapore. So, what’s working there.
People are talking about not opening up completely. You don’t say this county is open. That it’s not necessarily going to be by geography. That could be by, for example, we’ll have a lot of people who’ve developed immunity. So, those people can engage in activities, especially in healthcare.
If we’re talking about restaurants, perhaps restaurants have to open up with a different set of rules – you only have 50% of your capacity, so that you’re able to open but we’re doing it differently because we create social distancing.
Airlines might be able to open eventually, but they’re not going to be able to go at full capacity. And the question to the airlines – would you rather fly with 50% or no percent? And we’re going to imagine that a number of businesses will open, but not open like we were four weeks ago but open in very measured ways with specific populations.
We might, for example, open, but keep the stay in place, stay at home order for people who have healthcare vulnerabilities, maybe for the older generation.
So, I think we’re going to have to be smart about it, not to simply say, well, this set of counties just you’re, you know, you’re back to where you were, but rather how do we very, very smartly and very gradually, understanding the data that’s coming out of our experience here in the United States, as well as the data and the experience that’s coming out from other places.
I think one of the lessons of this whole experience has been, everything that we’re experiencing here in the United States has similarities to what we’re experiencing in China, and we could have done a better job at looking at people who are ahead of us on this curve, seeing what they did, what worked, and what didn’t work.
And then we ought to embed those lessons in the decisions that we make. And where they made mistakes, let’s not repeat those mistakes. And so, we’re right now in that learning curve. And that will inform when we open, how we open, but hopefully we’ll do it in a really smart way, in a very calculated way rather than just opening the doors.
Because if we just do that, we’re going to open the doors and then soon we’re going to get back to where we’ve been before where we have this spread of the disease. We got to be really smart when we start opening those doors.
I know that there are groups that are meeting and that are beginning to work on that, asking some of the really tough questions and coming up with creative strategies for how to reopen society once the numbers of cases start coming down.
Q: But do we – I know a lot of the talk has been about, you know, testing, right? Do we have that capacity right now to even get to the level where we can think about opening and, you know, start looking at what happened abroad? Or do we even – do we have to do more and just keep, you know, expanding testing, expanding testing, expanding testing?
LEONARD MARCUS: Well, you know as well as I do, whether we have the capacity now depends on who you ask. So, we don’t really fully know what the capacity is.
I do believe that if we look at the experience in South Korea, you know, one of the strategies that they employed was very widespread testing. And that widespread testing helped them discriminate those people who were able to go back to work and were able to reengage in society.
And with that, they’re also able to keep those people who tested positive out of the mainstream. So, it was an opportunity for them in a very, very staged, very carefully, very calculated way of discriminating between those people who are carrying the disease and those who are not.
And that is the advantage that comes in being able to build that testing capacity and not only the numbers of people, but the ease of testing. So that we’re now finding these very quick testing capabilities. That too from a calculated perspective, is going to help us reopen smartly.
MODERATOR: All right. Is there another question?
LEONARD MARCUS: Well, I’m going to – if you don’t have a question. I know that it’s not supposed to be this way, but the question I actually have a question for you. And I don’t know if anybody would be willing to answer this and maybe it’ll spark some more questions.
It seems that this is a very difficult story to cover and as I’ve been watching the media, it’s not a straightforward story. It’s an evolving story. There are a lot of unknowns and just to, you know, from my perspective as we’re studying leaders, as we’re studying and trying to understand what the media is doing, one of the questions for us is how difficult this story is because it’s very difficult to figure out what’s true and what’s not true. It’s very difficult to see what are the trends that are going on.
And it does appear that for every one of us, including myself, we’re not only trying to understand this experience, but we’re also living through it, which means that our families are living through it, our friends are living through it.
And so, you’re covering a story, and you’re also in the middle of the story, and nobody has to answer that question.
But just so you know that those of us that are trying to understand this bigger picture recognize that this put a tremendous stress on you and what you’re doing every day as well. And probably a story to be told when this is all over.
MODERATOR: Alright, well, if there are no other comments or questions I guess we’ll wrap it up for today.
Thank you, Dr. Marcus. And do you have any other final words before we end the call?
LEONARD MARCUS: Well, um, the question that I posed to you is one that we’re thinking about. And one of the things that we encourage people as they’re trying to make their way, because we all have to cope with this, That when it’s all done, we’re going to look back and ask ourselves the question, ‘how did we do’.
And hopefully we’ll be able to look back and say we’re proud of what we did. Those are very, very difficult circumstances, but in looking back, we did ourselves proud. And it’s hard, as we’re going forward into this to figure out, well, what does that mean, but one of the things I do for myself, and one of the things I encourage our students to do is to do something today for which you’ll be proud. Do something professionally that you say, Well, that was a good thing to do. And I’m proud that we were able to do that and do something personally that makes you feel like, well, I mean it was a tough time but I made it through well.
Personally, I try and reach out to a friend who hasn’t been in touch, or I haven’t been in touch with them for some time, and it’s a sort of lift somebody’s spirits.
So, think about even as you’re doing your reporting, you know, when you look back knowing that this is probably going to be one of the most difficult and perplexing periods of your career. Will you be able to look back and be proud of the reporting that you’ve done and the work that you’ve done? And what does it require in order to meet that standard? It’s a different standard than what any of us have done, and other times.
So, what’s the standard that you’re setting for yourself? Is it a standard that you feel serves now the people that are looking to you for information, that reflects well on your values as a journalist?
And then we will look back on this collectively. Journalism will look back on how well we covered a really, really difficult story, just as we in academia, the people at the front lines of emergency management, and people in the community will look back on this and say, did we do ourselves proud? Did our country do itself proud through this?
Because our ultimate resilience as a country, and our ultimate resilience as an organization, or as a profession will depend on whether we think we did well through it. So, that best investment in the ultimate resilience comes in doing ourselves proud as we’re going through this.
So, once again thank you for what you’re doing and through Nicole, if I can be helpful to you are going forward in your reporting, happy to be of assistance.
This concludes the April 10 press conference.
Paul Biddinger, vice chair for emergency preparedness in the Department of Emergency Medicine at Massachusetts General Hospital and medical director for emergency preparedness at the hospital and at Partners Healthcare (April 9, 2020)