You’re listening to a press conference from the Harvard T.H. Chan School of Public Health with Richard Serino, distinguished visiting fellow at Harvard’s National Preparedness Leadership Initiative, former Federal Emergency Management Agency administrator, and former Chief of Boston EMS. This call was recorded at 11:30 am Eastern Time on Monday, April 20.
Previous press conferences are linked at the bottom of this transcript.
RICHARD SERINO: Good morning everyone. It’s a pleasure to be with you this morning. I just wanted to open up with a couple of quick comments and then questions as Nicole mentioned. Remember last week and for a little bit, Dr. Fauci has been saying that the virus sets the timeline. And that’s true, but I think one thing that’s important is that the leaders are going to dictate the response and how they do, or don’t do that will actually dictate the number of lives saved and how and when we open safely.
One of the things that we see in most crisis is how do we plan for recovery. A lot of times we plan for response and this disaster pandemic is no different. And how do we plan for recovery. And recovery for this is going to be different than almost any other kind of disaster. But a couple of things that you have to remember in any disaster is that, you know, crisis is never just one thing. We are in the middle of a pandemic and there are obviously, many, many ripple effects. The first and foremost is the health and well-being of the citizenry of the world this time.
But also, how do we keep the healthcare workers, the EMTs, the paramedics safe; how do we continue to do that as we start to see the opening that’s going to happen gradually across the country; and how do we do that safely. I think one of the most, two of the most important things is trust and empathy. To understand that, we have to have trust in the leaders who are telling us what to do and how to do. The leaders also have to show empathy for those that we’ve lost, those that are suffering, and those that are working each and every day to get us through this.
So, I think as we start to look at this and how we’re able to do this and, you know, there’s lots of different ideas of how we’re going to open and I think it’s, they all have very good points in how we’re able to do that. One of the things is how are we going to do that is over, as we call it at the Harvard and the NPLI, is the arc of time and how that arc of time, specifically in this case, how we’re going to be able to do that, and the speed of the arc, which is different than the curve and flattening the curve, but how we’re going to be able to do that and how we’re gonna be able to that safely. And there’s a number of arcs over different phases, whether it’s the three phases the Federal Government put out or six phases that other people have put out, but how we’re going to do that and how we’re going to do that safely. And I think as we start to look at how we’re going to do that and understanding, you know, that we’re going to look at this from a government point of view, from a health point of view, from an economic point, of view, business point of view, but also as individuals, and how we’re going to be able to do that as individuals.
A lot of us has been sheltering place at home for, for a bit now, but how do we transition to the next part of where we’re going into the next phase. And what do we have to, how do we review whatever mitigation practices, how we’re able to support health care. How do we support the responders. And once we are sure of that and the testing, that never-ending testing, how we’re able to do that. But we also have to look at how we’re going to transform, how we’re going to transform how we live and how we’re going to be able to do that. You know, people who are going to work every day, and I am going to say this over and over again, the healthcare workers, the paramedics, the EMTs, that could literally put their lives at stake, is we – and I think we have to recognize and we’ve done a good job of that and I think we have to continue to do that as well as all the service employees, the people that are getting us food.
But how do we now in other businesses, whether it’s people talking about sports and just looking at you know televised game. But how do we transform and how we’re going to transform of what we do. And being transformational leaders, and there’s a number of points with that. I think the first one is we have to make sure to look at safety, to ensure that your employees are safe and it goes back to as leaders in a crisis, if people have to trust you and you have to show concern for what they’re doing in businesses.
And you have to listen to what they want and what you’re able to do. And, you know, writing a letter is usually not the best. Now, being in person is difficult, but, you know, there’s still the phone, there’s zoom calls, there’s Zoom videos, in acknowledging what they’re able to do. Now’s the time for innovation. You know who thought that we’d be able to do everything that we’re doing now on Zoom and not being able to, you know, going into the supermarkets is an adventure.
So I think there’s an opportunity here for innovation in transformation and we have to look at how we’re able to do that, how we’re able to encourage the ideas and you know, collaboration, and when things fail, we have to celebrate the failure in how we reopen. I’m not talking failure obviously in medicine, but talking how we can find the opportunity in a crisis to do things better. Never let a good crisis go to waste. And I mean that in a way that we can we can challenge ourselves to be better in how we’re able to move forward.
Oh, I’ll just pause now and then probably take some questions.
MODERATOR: Thank you, Rich. It looks like, first question?
Q: Hi yes, I was wondering if you could address us the idea of immunity passports or certificates and what are, I guess, some of the scientific as well as ethical considerations and you know is, is this something that the US is considering seriously right now? How would these work?
RICHARD SERINO: Sure, I cannot speak on whether they’re seriously considering it or not because I’m not government anymore. However, I think that this some efficacy in it but I think in this country, you see the challenges here that you haven’t seen in other places is going to be a lot of the privacy concerns that go along with that. If we can overcome the privacy concerns, then I think here is some good possibilities that you could see it. But right now, until the privacy concerns are addressed, both for the individuals to have that faith and trust in it, as well as for the medical community to have faith and trust. I think once you have those two then you can move forward. Without those, I see a very difficult time in this country for people to agree to sharing a lot of that information. If they can overcome those concerns, I think we will be – and I know a lot of people are working on it but I think in other countries where they didn’t have as many of those concerns that will be I think a bigger issue.
Q: Okay, thank you.
MODERATOR: Any other questions?
Q: Thanks for having a call, as usual. You know, we’re starting to kind of talk about preparing for a potential second wave and this strategy that’s out there of test, trace, and isolate. You know, we have a lot of questions for Florida’s DOH right now, about how they’re going to get to that point in testing. Right now, we’re doing a lot of our contact tracing of students through the universities so that’s, you know, I think a work in progress. And then isolation, I don’t think we really have a good idea of how we’re going to do that, whether we’re going to continue to have home isolation or potentially some alternate treatment sites. With all that said, I was just curious if you have any thoughts about that general framework as far as the strategy and whether all three of those are needed, or if you just need testing as some people are saying and kind of how to balance that and maybe what to emphasize over other things?
RICHARD SERINO: I think you’re going to need – it’s not going to be one thing that’s going to get us through this pandemic and this crisis. I think trace-test-isolate is going to be needed going forward. And I think that’s just one part of it. And until we have all the testing, we’re not going to be able to get there. And that’s going to help us as much as you know, the self-stay-at-home, self-isolation, it’s been working to really flatten the curve, and we’ve seen it working. I’m here in Boston, and we’ve, you know, we’re seeing the peak of it, but if we didn’t have this isolation, the peak would be much higher.
And if people continue, we’ll see another peak going up if we don’t continue this self-isolation for a while. But what I think is, once you have the testing at a significant number and you’re able to trace and isolate people, that’s going to help so we don’t have another peak. But we also have to be able to pivot quickly. I think in most crisis, pivoting is always key, is understanding to say, let’s not wait until we have huge numbers to pivot. I think soon if we can isolate individuals and slow the spread during the second wave.
There’s obviously a lot of talk of how we did it in 1918. In the spring, there wasn’t a huge surge, but then the fall, we saw that even deadlier surge. There are many things different than 1918. First off is the fact that we’re able to communicate, like we are now via Zoom video. But it’s not just us communicating, it’s scientists all over the world and spreading the word And the media in 1918 also downplayed it initially and obviously that’s not happening now.
So, I think that in, we also are able to communicate with each other – citizens, government officials – much quicker than we were in 1918. Science is decidedly different since 1918. The virus is still strong, obviously. But there’s many things that are different. So, I’m optimistic that yes, we can look at going forward, but we have to look at it in multimodal facets and I think it’s the test-trace-isolate. I think it’s communications. I think it’s science. A vaccine is still going to take, you know 18 months or so to have a vaccine, but there may be treatments that are available. We’re able to isolate quicker. We can keep track of numbers much better across the country, across the world.
So, I think that it’s in a different place, and hopefully that’s going to help us. But that’s going to take the whole community effort. It’s going to take citizens first. It’s going to take the faith-based communities, it’s going to take non-profit agencies. It’s going to take the federal, state, local, tribal, and territorial governments to all come together. This is going to be truly a whole community effort as we move forward to stop this. And it’s also going to take the business community. It’s going to play a huge role in how people are able to come back to work and how people are going to come back to work in stages. And as I mentioned earlier, it’s also an opportunity to do new things differently. And we have to look at this as an opportunity in the midst of a horrendous crisis as well.
Q: On each one of these points, and thank you, what does sufficient testing capacity look like, and then kind of, in addition to that, separately, when we’re talking about the isolation component – you know here in Miami, as I think a lot of metro areas in the country, we have pretty stark disparities in terms of access to health care. And we saw story in the New York Times over the weekend about someone who was turned down for treatment multiple times and ended up dying. How do we kind of solve that issue, and is the fever clinic model a plausible way to set up places where if someone’s sick, but maybe not necessarily sick enough to be hospitalized, that they have places to go so we can ensure that they’re not spreading the virus, and also that they’re not going to crash without anyone there to kind of intervene? So those are my two follow up questions.
Richard Serino: Sure. I think on the health disparities, unfortunately, that’s not new to the coronavirus. It’s, I think, highlighting to a lot of people that maybe didn’t notice it before, but it’s something that I know here in Boston and in New York and other cities have been dealing with for a long time and making some progress. For example, in Boston, at Boston Hope, which is their treatment center near the convention center, half of the beds, 500 of the beds there are specifically for homeless populations and people who don’t have access to healthcare. So, I think that’s a start.
But the disparities in health care, this is shining a light on what unfortunately happens each and every day. And looking at opportunities on how to house people who don’t have housing. And people who do have housing, I think the isolation that, if you remember towards the beginning of this, there was a lot of isolation. Before everybody was asked to stay at home, there was a lot of isolation and the vast majority people did stay home before the stay at home order when they were ordered to. If necessary, the very, very few handful of cases that I remember hearing about that people didn’t follow those orders.
So I think the vast majority people will follow the orders to isolate at home. The key is providing them with the wrap-around services that they need to stay at home. And that’s better than going to a congregate shelter. If they have no home, obviously, that’s the place to congregate shelter, specifically for COVID-19 patients. But providing the wraparound services in order to encourage that they can stay home, whether it’s at home nursing care and making sure they have food, and I know New York City has done a good job of looking at how to do that, to provide those wraparound services as well. So, I think that, you know, it’s highlighting what this country has seen for a while with health disparities.
MODERATOR: Any other questions or are you all set?
Q: Yeah, just the first part of that, what does sufficient testing capacity look like, um, as far as, you know, how do we know when we’re there. I know the New York Times had a story recently, basically, so do you need to triple the current capacity to be able to run all these tests and you know, given the uncertainties about the accuracy of the serological antibody tests do you see this, you know, how do you see that this testing capacity being deemed appropriate to reopen.
RICHARD SERINO: First off, I’m not a scientist so I want to make that clear. But I think that there’s also, the testing, I can’t give you exact number now, but obviously it has to be increased. And the amount that we can increase so that we have good data to show where we are. We’re nowhere near that data now, we’re still having people have difficulties getting tested and issues on a day to day basis.
Also, I think that the other tests that we need to do is the vast amount of people that are unfortunately dying at home. In some cities, we’re seeing, you know, 10 times the normal deaths at home than we see in a normal time, and some of those and not being counted as COVID-19 deaths. So, I think we’re also seeing the secondary part of people who have COVID-19 dying at home and also people who are dying home because they are not going to the hospital for other ailments. So, I think we have to do a lot of, we have to look at that, even more detail of the number of people that are dying home, both for testing purposes, but also to get a true number of the people that are dying and the ones that are related not specifically to COVID-19 but because of COVID-19 as well.
MODERATOR: Okay, thank you. Next question?
Q: Hi, good morning. Thank you for taking my question. There’s a story in the New York Times today about antibody testing being used inappropriately by some clinicians. And you alluded to this issue a little bit in your previous answer here, but I’m wondering how much of an issue – even if we get adequate supplies and capacity for antibody testing and testing for COVID-19 in general, how much of an issue is that communication and education of providers and also cost associated with getting these tests out and healthcare systems being able to afford to acquire them?
RICHARD SERINO: I think a couple of points. I think, first on the tests, the training for people on how to use them and how to interpret results is going to be key. I mean we saw that initially with even some ventilators and the different types of ventilators and getting people trained, so I think education and training is going to be key.
A number of private laboratories and hospitals are putting a lot of time and effort into training and getting the right amount of people on board in order to do that. The cost is also an issue that hospitals are dealing with, private labs are dealing with across the country and I haven’t seen the latest version of the latest stimulus bill, but I understand that some monies in there specifically for hospitals in this and that’s going to be key in order to continue the testing going forward as well.
Q: Thank you.
MODERATOR: Next question?
Q: Thanks so much for taking my question and talking with us today. I’m curious if you feel like state and local leaders might be missing the mark, possibly in talking about, you know, quote-unquote reopening the economy, as if it’s sort of that simple, as if it’s going from close to open. Should they be talking about it differently, and are there nuances and what they can do that are being missed when we talk about it like that?
RICHARD SERINO: Well, I think, state and local leaders, especially those who are dealing with the surge right now, their effort initially, and here in the Boston, Massachusetts area specifically now is seeing the surge, is on saving lives and making sure people are healthy. So, I think that that’s appropriate.
At the same time, cities that are in the surge or have gone, or are going through the surge now, they’re also planning how do we reopen. And this is something that state and localities are wrestling with because one thing you don’t want to do is do this wrong. Because if you do it wrong in the beginning, it’s going to be difficult for people to believe and trust in their local and state government, so you have to get this right.
I mean, we’ve seen protests all over the country and when you look at the number of protesters and some of them over the weekend, you know, there’s a hundred here or a hundred there, but you also have to look at the hundreds of millions that are following the stay-at-home. You know you don’t see, you know, huge stories on that. So I think that we have to be careful that a hundred protesters – and they have a right to protest, but let’s not blow it out of proportion for the amount of people that are actually following it, in some of the polls and I’m sure you’ve all seen, show the vast majority of the country feels that you have to go at this slowly.
And I think for local and state leaders, you know, over the last few weeks I’ve watched, they have garnered a lot of trust with people and they’ve shown empathy and as I mentioned at the beginning, I think those are two of the most important things that people can do. And as you start to open, you know, restaurants, you know, if they have, for example, had 100 people. And what we’re going to probably start with 50, maybe a few less in there and how people are going to be presenting the food is going to be different.
I think it’s going to be a gradual and then this is again where businesses can play a key role. This cannot just be a government-led issue. I think for the recovery, this is going to have to be bringing in the community leaders and listening to what others have to say. And that means, you know, local Faith-Based groups. It can mean local small businesses to local big businesses, who are the largest employers in your area and get their input. Give them some ideas as well. And getting your workers back to work and keeping them safe and then keeping people who are coming safe. So, I think it has to be a gradual process. It has to be done transparent. You have to bring people in from the entire whole of the community as you start to open in a gradual process.
MODERATOR: While we’re waiting, I have a question. So, and I’ve never asked a question before, but I’m going to go ahead. So last week, on Tuesday, Stephen Kissler, Christine Tedijanto, Marc Lipsitch and Yonatan Grad all published a paper in Science saying that they could see us going through basically cyclical self-isolation until 2022. How do you foresee that as being a different type of challenge from other crises we’ve had in the past? Usually it’s a one-time event, and it seems like this may be more cyclical than one-time. Do you see how the next round of self-isolation could be implemented differently or how do you see this going moving forward?
RICHARD SERINO: A couple of things. I think first off, that this is, you know, it started out as novel coronavirus. It’s also a novel disaster of the likes that we, most of us, in our lifetimes haven’t seen before. And I think how we’re able to adjust to this is going to be key. In most disasters, you know, whether it’s a hurricane or a flood or a tornado or even, you know, a bombing, as we saw here in Boston seven years ago, that it was an event, recovery was fairly quick. Sometimes, it took a week to get there, after the hurricane died down, after you know, suspects were captured or whatever.
But there was clearly an end, and without a clear and it’s going to be difficult for people to adjust. And, you know, we talked about a new normal, Juliette Kayyem calls it “the now normal.” And I think how we look at where we are now and where we’re going to be month, to where we’re going to be two months, nevermind in 18 months, is something that we all have to adapt to.
And we all have to have input in how we’re going to get there because it isn’t going to be just, as I mentioned earlier, everyone just saying this is what we’re going to do. Because the new normal is going to be difficult. And it’s going to change from what it is now, to what it’s going to be in two months, to what it’s going to be in six months, to where we’re going to be in a year from now, and it’s going to change. And I think the hardest thing for a lot of people to do ever is change.
And that’s why is, as I mentioned earlier, looking at this in, you know, an arc of time. And as you look at the arc, and look at the various scenarios of how we’re going to be there over a period of time, and each one of these arcs is going to take longer to get to the point of where we need to be, you know. There’s a worst-case scenario for the arcs, there’s also the best-case scenario for the arcs. And how we’re able to, you know, get through the response in a way that we’re all going to be able to adjust to the now normal and where we will be able to go in the future.
So, it’s not just one phase. I think we’re going to all have to adapt as we go forward, that this is not going to be something that we’ve seen before. And this is where I think we’re going to have to be able to listen to each other. Because everybody has their own concerns. We’re going to see a new surge of, once this surge is down, at the hospitals are people who haven’t been able to go to the hospital for three months, for just a routine test. So once that the surge from COVID-19 goes down, presuming we don’t have another surge and people continue to follow the requests to, you know, “wear masks,” “six feet apart,” certain people to stay at home. After it’s over, we’re going to see a new challenge as we move forward.
And I wish I could sit here and tell you exactly what that’s going to be, but I don’t think anybody knows exactly what that’s going to be. As we look at, you know, the phase from, you know, the outbreak where we are now to the next phase of monitoring cases and continuing, you know, care for the people who are ill, and then we stopped to look at how we begin the recovery. Some places are moving towards that now, some places are still in, you know, the outbreak. But then how do we monitor the disease transmission, then to start actively recover, you know. How are we going to look at once we have the testing, businesses and schools slowly reopen, more widespread testing, and then start to look at how we can monitor the disease and respond to new cases quickly. Because we will see that it will be how do we respond to that and how do we continue to recover.
When this first started in this country and we started having shelter in place, stay at home requests, stay at home orders. People are used to that now, whereas initially they weren’t. Say okay, we want this section of the population, this location to work at home. But I think as we continue to do this, as we continue this look for new cases we have to also look at how we can look at continuing to do treatments. And vaccines are going to be as mentioned, you know, at least 18 months away and then to, you know, treat the whole, vaccinate the entire population is going to take you longer. It’s not like there’s going to be one song then everybody’s going to vaccinate. So that that adds some more time.
So I think as we start to look at these, you know, various arcs of time, then hopefully, you know, in a post COVID-19 world, it’s not going to look the same as it looked, you know, four months ago.
MODERATOR: Okay, thank you.
Q: Um, yes, I had a question. So, so much of what the talk and focus of the so-called reopening is on the economic or business aspect of it. And I’m wondering if you have thought about or people have been thinking about some of the secondary or knock-on effects that the shutdown will create or is creating. I’m just thinking of people who have not had, you mentioned elective surgery but dental treatment, kids that aren’t really doing the school work online, etc. There’s all kinds of things. I’m wondering if that’s been talked about and what kind of secondary effects or consequences should, you know, big cities and towns be anticipating as a result.
RICHARD SERINO: Sure. I think a few things on that, is not just, you know, like I mentioned the surge in the healthcare community, you know, dentists, everywhere. Getting your hair cut, there’s going to be a surge. Although that’ll be later. But understanding that it will be this surge.
But I think one of the biggest things that we haven’t talked about yet is the mental health issues. The mental health issues for all the first responders, and I include nurses and doctors and hospital staff with that, the paramedics and EMTs that unfortunately we see are getting sick and a number that have lost their lives in other places. And here in Boston, New York City. both doctors, nurses, paramedics police officers. So, I think the mental health effects are going to be long and hard just been New York City. We have to remember that the number of people that died in New York City surpasses 9-11 and Pearl Harbor combined, just in the city. So, the mental health effects that we saw from 9-11 were a long term and still going on. So, we are going to see that.
And that’s just in the first response community. In the mental health effects, I think, you know, whether it’s children not being able to see their friends they go to every day, to, you know, people who were at home. So, I think dealing with, the mental health effects are going to be huge and long lasting.
As we start to think of, you know, how do we look at opening up areas, you know, what’s the, you know, people who have society benefits, how are we going to be able to start to open up to, you know, are we going to have a stronger healthcare system, you know, or is it going to be damaged because so much has gone on.
So, I think, looking at that, I think that as we start to, you know, go forward, the continuing to test widely, isolate people that are affected, look at, you know, how we contact that. But I think we’re going to have to also really look at the long-term effects because it’s obviously huge economic impacts. We’re not going to come out of this, you know, people say like flicking a light switch is not going to happen.
So, it’s going to be gradual which means the economic recovery is going to be gradual. But to me, one of the biggest issues after the primary health effects of saving as many people as we can with social distancing and unfortunately if they have to go to the hospital for treatment, is going to be how we deal with the mental health effects of those who have been dealing with it on the front line and those who have been dealing with it at home as well. Dealing with those is going to be, I think, just as important an issue and a much longer tail on this than perhaps the pandemic itself.
MODERATOR: Thank you. Rich, do you have any other final words you’d like to say before we end the call?
RICHARD SERINO: I think a few things. I think we have to focus on the positive to show that you know there has been, you know, a lot of lives saved, a lot of lives lost. For those who heard my, I did a short video for NPLI, the National Preparedness Leadership Initiative talking about hope. But I think we have to emphasize the positive, as well.
We have to learn that we have to come together, that together we can solve a lot. We have to, you know, acknowledge and mourn the people that we’ve lost. We also have to celebrate the lives that have been saved. I think that we can come out of this stronger if we come together. We have to, you know, continue to look at how we can solidify the connections between people who are in the front line and leaderships. And I think leaders, now more than ever have to be able to again show that empathy, show that they have trust in a crisis.
But also, not to take things personally. It’s not about what an individual can accomplish. Now actually, more than ever, it’s going to be a collection of people, of what we can accomplish as a group of people coming together is going to be how we’re going to get through this. We’ve said, some of us in disaster circles for years, “It’s not going to be one city that can handle this, one state that can handle this. It’s not one country that can handle this. This is going to be truly all of us coming together.”
And as we talk about in meta-leadership is, you know, we have to be able to, all of us as individuals, how we’re going to be able to lead up, to lead down, to lead across people we work with, and lead beyond as we understand the ever-changing situation and understand yourself as well.
And with that, I think that we have an opportunity. We have to get through this. We will get through this and every crisis comes to an end. This one may be a little further out, but I know if we come together, we can solve this.
This concludes the April 20 press conference.
Michael Mina, assistant professor of epidemiology (April 17, 2020)
Karestan Koenen, professor of psychiatric epidemiology (April 16, 2020)