Speaker 1: This is Masters in Business with Very Results on Bluebird Radio.
Speaker 1: This week on the podcast, I have an extra special guest,
Speaker 1: and strap yourself in because this is going to be fascinating.
Speaker 1: Charity Dean is the protagonist of Michael Lewis's new book,
Speaker 1: The Premonition. She's also I'm going to give her a
Speaker 1: promotion the head of public health of the California Public
Speaker 1: Health Department as well as the co founder of the
Speaker 1: Public Health Company. And if you are at all interested
Speaker 1: in how infectious disease spreads, what we're doing right and
Speaker 1: wrong with vaccinations and containing COVID, and what the risks
Speaker 1: are that we're looking at from our current circumstances, including
Speaker 1: the very dangerous delta variant, you're going to find this
Speaker 1: to be an absolutely fascinating conversation. So, with no further ado,
Speaker 1: my conversation with Charity team, this is Mesters in Business
Speaker 1: with Very Results on Bloomberg Radio. My special guest this
Speaker 1: week is Dr Charity Dean. She was the deputy public
Speaker 1: Health officer for the Santa Barbara County Public Health Department
Speaker 1: before becoming assistant director at the California Department of Public Health.
Speaker 1: In Michael Lewis called her one of the few people
Speaker 1: who saw the real danger of the COVID virus before
Speaker 1: the rest of the country did, and she was featured
Speaker 1: as one of the main characters in his book The Premonition,
Speaker 1: a Pandemic Story. She is co founder of the public
Speaker 1: health company Charity Dean. Welcome to Bloomberg. It's a pleasure
Speaker 1: to be with you. I'm really looking forward to this conversation.
Speaker 1: I loved the book. I mean, I love everything Michael
Speaker 1: Lewis writes, but the book was especially interesting. But I
Speaker 1: want to roll back and start um with your back round.
Speaker 1: Tell us what a public health officer is and how
Speaker 1: did you become one. Well, a public health officer is
Speaker 1: the local official for a county or a local jurisdiction
Speaker 1: who is responsible for ensuring that the public is safe
Speaker 1: against a host of different types of threats. MY favorite threat,
Speaker 1: of course, is communicable disease control. But there's a number
Speaker 1: of things they do. They oversee restaurant inspections or water safety.
Speaker 1: I think the thing they're best known for, though, really
Speaker 1: is disease threats. Because in the US, public health officers
Speaker 1: sprung up across the US and responds to local needs.
Speaker 1: You know, if we rewind a hundred years that might
Speaker 1: have been tuberculosis or smallpox or cholera, polio, etcetera. So
Speaker 1: today the local public health officers are largely unknown to
Speaker 1: the general public, but their role is really important. And
Speaker 1: in the book The Premonition, we learned that the local
Speaker 1: public health officers have a lot of authority. They can
Speaker 1: shut down doctors if they're a source of um malpractice
Speaker 1: or a source of infection or in fact, there's some
Speaker 1: really fascinating stories. People kind of push back and say,
Speaker 1: you can't do that, and the answer seems to be
Speaker 1: watch me well. I learned that on the fly when
Speaker 1: I became the health officer for Santa Barbara County. The
Speaker 1: thing that intrigued me the most is called layer jurisdictional authority,
Speaker 1: and what that means is the police powers to enforce
Speaker 1: communicable disease control in California set with the local health officer.
Speaker 1: In some states they sit with the state health officer,
Speaker 1: but in California it's with the local county public health officer,
Speaker 1: and the law actually says that they can take whatever
Speaker 1: measures are necessary to control the spread of disease. And
Speaker 1: that's an incredible amount of police power. Authority, and it's
Speaker 1: a huge responsibility. So really it's the job of the
Speaker 1: local public health officer across the United States to protect
Speaker 1: national security, health security, and now after COVID, we know
Speaker 1: even the outcome of the local economy is impacted by
Speaker 1: the decisions they make. Quite quite interesting. What was your
Speaker 1: early experiences with infectious diseases? How did you gravitate in
Speaker 1: that direction? You know, I was always interested in outbreaks,
Speaker 1: even as a child. I was interested in pandemics um
Speaker 1: as a child. As a child, I was interested in
Speaker 1: the really awful gnarly hemorrhagic viruses that we see in
Speaker 1: in Africa and interested in how they spread silently. And
Speaker 1: I love bubonic plague. And I read about the Spanish
Speaker 1: flu of nineteen eighteen, and cholera outbreaks, and just a
Speaker 1: host of different diseases that have swept through society. So
Speaker 1: when I went to college at age seventeen, I was
Speaker 1: premed and I majored in microbiology, because that's where you
Speaker 1: learn about all those horrific diseases. I don't think I've
Speaker 1: ever heard the sentence quote I love bubonic plague unquote
Speaker 1: ever ever stated before on at least not on this
Speaker 1: radio station. Well, it's fascinating, right, I mean, public health
Speaker 1: disease control has shaped societies, Its shaped the world, and
Speaker 1: if you look at you know what's impacted societies and economies,
Speaker 1: it's it's been disease. And what's what's the biggest intervention
Speaker 1: public health has had has been vaccines, um and today
Speaker 1: people tend to think it's something that is uh the
Speaker 1: underbelly of society that they don't have to worry about.
Speaker 1: Government's got that if that risk ever arises, government will
Speaker 1: come and save us. But as local health officer, I
Speaker 1: figured out really quickly, Uh, no one's coming to save you.
Speaker 1: And yet you have this enormous responsibility. And if you're
Speaker 1: really good at your job, nobody knows because that means
Speaker 1: you've prevented it. You've stopped the outbreak. Right, they find
Speaker 1: out when you mess up, and giant thing of merca
Speaker 1: spreads all over the county. So how did you work
Speaker 1: your way from Santa Barbara to State of California. Well,
Speaker 1: I was the local health officer in Santa Barbara over
Speaker 1: a number of different outbreaks disasters. I was the health
Speaker 1: officer there during the Thomas Fire, which at the time
Speaker 1: was the largest fire in the history of California. It's
Speaker 1: a strange time of year. It was in December and
Speaker 1: it was followed by a really powerful rainstorm that led
Speaker 1: to the Mona Cito mud slides. And as I was
Speaker 1: managing a number of different health risks around the mud slides,
Speaker 1: not just communicable disease, but a host of other things,
Speaker 1: I was in close, close communication with a state health officer,
Speaker 1: Karen Smith, who was my person to call. You know,
Speaker 1: when you're a local health officer and you need backup,
Speaker 1: you need a thought partner, you call the state. So
Speaker 1: Karen and I spent a lot of time on the phone,
Speaker 1: and shortly after that, she called me one day and said,
Speaker 1: what would you think about moving up to Sacramento to
Speaker 1: be my number two? And I said yes, and uh,
Speaker 1: that's how the adventure started. And I had always I
Speaker 1: thought that that's where I wanted to end up, was
Speaker 1: being state health officer, because I thought I could have,
Speaker 1: you know, an incredible amount of impact there at that level.
Speaker 1: But California has forty million people, and California is really
Speaker 1: like its own nation. It's so diverse. So it made
Speaker 1: me nervous moving from making risk based differential diagnoses on
Speaker 1: behalf of four people at the county to doing that
Speaker 1: at the state on behalf of forty million people. So
Speaker 1: it's a different comfort level, right, stakes are higher, stakes
Speaker 1: are higher, and mistakes are are more costly. And but
Speaker 1: the same problem. If you succeed, nobody knows. It's always
Speaker 1: the challenge of public health because we succeed and then
Speaker 1: it's silent and you can't see that succeed in the
Speaker 1: data and statistics if you're not tracking outcomes. And traditionally
Speaker 1: public health disease control does not have a good way
Speaker 1: to show return on investment other than nothing bad has happened.
Speaker 1: Money must be well spent. But that's it's hard to
Speaker 1: prove a negative, isn't isn't it? It is hard. We
Speaker 1: can get to that later because I'll tell you why
Speaker 1: I'm so passionate about the private sector need for this
Speaker 1: and the mandate to show return on investment. So before
Speaker 1: we get to the private sector, and I have lots
Speaker 1: of questions for you about that. You were also the
Speaker 1: co chair of the California Testing Task Force for COVID
Speaker 1: nineteen and you ramp that up to over a hundred
Speaker 1: thousand tests a day in a very short period of time.
Speaker 1: Tell us about that. That sounds like a giant logistical undertaking.
Speaker 1: It was. It was the greatest experience in rapid project
Speaker 1: management I've ever had. And I would be remiss if
Speaker 1: I didn't mention my amazing co lead, which is Paul Markovitch.
Speaker 1: He's the CEO and president of Lucille, California. And what
Speaker 1: happened is there was no testing in California or anywhere else.
Speaker 1: The state was only able to do about two thousand
Speaker 1: PCR today. And the backstory, as you know, is the
Speaker 1: CDC and f d A had said nobody could test.
Speaker 1: Wait for the CDCs test, so we waited. They rolled
Speaker 1: it out, it didn't work. They said, wait, we'll fix it,
Speaker 1: So we waited. They rolled it out again, it didn't work,
Speaker 1: and so the United States missed that critical two month
Speaker 1: window of containment. Without testing, there's no way you can
Speaker 1: contain a threat because you can't find it. So by
Speaker 1: the time they opened the floodgates that any microbiology lab
Speaker 1: could test, the problem was that the labs weren't doing it,
Speaker 1: and we had supply chain issues where everyone needed the
Speaker 1: same testing supplies, and so we were asked, Paul and
Speaker 1: I were asked to found and stand up the Testing
Speaker 1: Task Force to fix testing for California and tell us
Speaker 1: what you did, because California, at least in the beginning
Speaker 1: of the crisis, seemed to have done a much better
Speaker 1: job than a lot of other states, especially when you
Speaker 1: consider the outbreak was in Washington, not that far away
Speaker 1: from Cali. For it from Seattle, Washington. Yeah, well, I
Speaker 1: would say the outbreaks were invisible. Communities in California were
Speaker 1: burning up with COVID. It's just math and microbiology. I
Speaker 1: was whiteboarding it out, you know, at home on my
Speaker 1: white board. I knew exactly how many cases I thought
Speaker 1: there were. The problem is we couldn't detect community spread
Speaker 1: without testing, and so Paul and I put together a plan. Essentially,
Speaker 1: I'd break it down in terms of supply and demand. Uh,
Speaker 1: we were doing two thousand tests today. Our objective was
Speaker 1: to get to a hundred thousand tests today. We ended
Speaker 1: up blowing through that. We got to about a hundred
Speaker 1: and forty thousand test today, much sooner than we thought
Speaker 1: we would. And so the supply part is you need
Speaker 1: to actually have the testing, you need to have testing
Speaker 1: locations throughout the state. And the demand part is you
Speaker 1: need people to show up and get tested, and so
Speaker 1: we broke it down into project management. We had task
Speaker 1: forces and work streams, and we had daily stand up
Speaker 1: meetings twice a day. Was eighteen hours a day sprint,
Speaker 1: you know, for about twelve weeks, and the way that
Speaker 1: we managed it was just getting really tactical and operational.
Speaker 1: Um At one point, I rewrote California's guidance for who
Speaker 1: could be tested on a Friday night and we published
Speaker 1: it on the website on a Sunday night, and it
Speaker 1: was far more aggressive than the CDC's guidance. But we
Speaker 1: needed people to show up to get tested, and the
Speaker 1: CDC guidance was so restrictive nobody could get tested. What
Speaker 1: was the CDC guidance? Because you would think, if you're
Speaker 1: trying to stop an epidemic that could spread to anybody
Speaker 1: with a respiratory system, you would want to say, that's
Speaker 1: our our guideline. If you breathe there, you're eligible for testing.
Speaker 1: That's that's right, That's what it should have been. The
Speaker 1: CDC's guidance was very restrictive at that time. You had
Speaker 1: to have symptoms, you had to be in certain risk
Speaker 1: categories exactly and so so you know, from a practical
Speaker 1: public health standpoint, the CDC's guidance was literally counter productive
Speaker 1: to public health. And so looking at what we need
Speaker 1: to do, we have to test essential workers. Obviously they're
Speaker 1: on the front lines, and so putting it in buckets
Speaker 1: that made more practical sense. Yeah, prioritizing them is really
Speaker 1: what drove people into the testing centers. And so in
Speaker 1: in parallel to that, we set up over the course
Speaker 1: of two weeks, we stood up eighty testing centers across
Speaker 1: the state of California, which is a big state, and
Speaker 1: then of course revised the guidance for folks to get tested,
Speaker 1: you know, started driving in people to those locations, and
Speaker 1: so that's how we scaled it up quickly. Yeah, I
Speaker 1: was kind of shocked in the early days of testing
Speaker 1: that if you're an NBA player you can get tested,
Speaker 1: but if you were a grocery worker deliveries into people's houses,
Speaker 1: that's right, if you were literally going from place to
Speaker 1: place as a supercarrier, you couldn't get tested. It made
Speaker 1: no sense early days, that's right. It was bonkers, and
Speaker 1: that's why the United States failed at containment. You know,
Speaker 1: once you once you lose your chance to contain the threat.
Speaker 1: Then you get to choose between something horrible and something
Speaker 1: even more horrible, and that choyce of you know, massive
Speaker 1: outbreaks everywhere and bad health outcomes and the economy. I
Speaker 1: believe it's a false choice. If you put all your
Speaker 1: energy at containing the threat in the beginning, and without
Speaker 1: testing and without an operational infrastructure to contain COVID, the
Speaker 1: US had no shot. There was no effort to contain
Speaker 1: the pathogen in the beginning, which is why we're in
Speaker 1: the circumstance we are. Now, let's talk a little bit
Speaker 1: about where we are today. You've seen the best and
Speaker 1: worst parts of the nation's medical system. What's your takeaway
Speaker 1: about how well we did, how well should we have done?
Speaker 1: And where did we go wrong? Sure, I would start
Speaker 1: off by saying the COVID nineteen containment effort did not happen.
Speaker 1: So that was a massive failure. But it didn't happen
Speaker 1: because the United States of America does not have a
Speaker 1: system's capability to contain a fast moving, novel pathogen that
Speaker 1: emerges simultaneously at multiple locations in the US. Isn't that
Speaker 1: in the modern world? How? I mean, we've seen a
Speaker 1: Bola in Africa where it's restricted, but there's no NASS
Speaker 1: transit aircraft. People hopping on a plane in one continent
Speaker 1: and eight hours later on a different continent. That's a
Speaker 1: very different world and economy. But in a modern interconnected economy,
Speaker 1: isn't that how things are gonna pop up? There's going
Speaker 1: to be the first super spreader can seede a million
Speaker 1: people pretty quickly. Yeah, you're exactly right. You know, my
Speaker 1: master's degree is in tropical medicine, which really is an
Speaker 1: antiquated term. The diseases that we formerly thought were tropical, now,
Speaker 1: thanks to globalization and and to some degree global warming,
Speaker 1: can move much faster. And so what we're seeing is
Speaker 1: that the pandemic pathogen spread has sped up, the risk
Speaker 1: is higher, and those events are happen more and more frequently.
Speaker 1: All right, So now we know we didn't do a
Speaker 1: great job with containment. We did no job with containment. Um,
Speaker 1: what about creating the vaccines? We seem to have done
Speaker 1: a pretty good job with that. We did. The vaccines
Speaker 1: were a shining success. You know, I think what Operation
Speaker 1: Warp speed accomplished and full disclosure. Um, those guys are
Speaker 1: my friends, Uh, they're Wolverines. And so you know from
Speaker 1: the book from the Bush administration, the group who essentially
Speaker 1: created the pandemic response, someone else in the White House
Speaker 1: named them the Wolverines. I don't remember why. I think
Speaker 1: there's some It was after a silly nineteen eighties movie
Speaker 1: with Patrick Swayze called Red Dawn. Yeah, yeah, so I
Speaker 1: think it was Richard Hatchett that nicknamed them the Wolverines
Speaker 1: after this Red Dawn movie, and that was the name
Speaker 1: of our email chain. But listen, even if they're not
Speaker 1: your friends, even the most anti Trump hater in the
Speaker 1: world has to admit that was the most successful thing
Speaker 1: of the entire administration of vaccine was not only was
Speaker 1: it created, it was safe, it was effective, and they
Speaker 1: made sure that there would be sufficient doses at least
Speaker 1: three quarters of the way. Make sure they were a
Speaker 1: ton of doses in the you know, early days of
Speaker 1: the vaccination process. That's right, Operation warp speed. To develop
Speaker 1: a vaccine as fast as they did is a shining
Speaker 1: success and there are many lessons learned from that where
Speaker 1: we can get even better and faster. I think the
Speaker 1: other success is the private sector. What we saw during
Speaker 1: COVID and what I certainly saw a leading California in
Speaker 1: the testing task force is the private sector ran to
Speaker 1: the fight. They said, our resources are at your fingertips.
Speaker 1: How can we help you. You know, you look at
Speaker 1: different companies, whether it's you know, the pharmaceutical companies that
Speaker 1: developed the vaccine or the testing companies that quickly developed
Speaker 1: rapid tests. The private sector played an incredible role. I
Speaker 1: think what's frustrating to me, you know, when I was
Speaker 1: in government was that there was really a struggle to
Speaker 1: leverage the private sector in the response. Meaning up to
Speaker 1: this point, the response for public health was seen as
Speaker 1: government's role alone. That didn't work. It has to be
Speaker 1: a whole of society response. We have to have a
Speaker 1: place for individual citizen volunteers, for the private sectors that
Speaker 1: the whole society responds together instead of government trying to
Speaker 1: peace mill it on their own. So let's stick with
Speaker 1: the vaccinations. The numbers we're going up enormously in different
Speaker 1: parts of the country, and then everything seems to have plateaued.
Speaker 1: We we were going three million a day, two million
Speaker 1: a day. We seem to be getting close to national
Speaker 1: herd immunity. But when you break it down on a
Speaker 1: state and county basis there are that whole supercluster between
Speaker 1: Georgia and Texas. Is you know, vaccination rates you look
Speaker 1: at the Northeast, you look at parts of the West,
Speaker 1: and and the industrial Midwest are running well over fifty
Speaker 1: percent in some places. Um, how do you evaluate the
Speaker 1: state of our our vaccinated nation or not? You know,
Speaker 1: it's a shame that vaccinations have become so politicized because
Speaker 1: it's really just science. It's microbiology and math. The equation
Speaker 1: for her immunity is one minus one over are not,
Speaker 1: and that are not is how many people will one
Speaker 1: contagious person infect? So there are not of the original
Speaker 1: covid virus was somewhere between two point five and three
Speaker 1: that are not. Of the delta variant is somewhere between
Speaker 1: five and eight. That means one contagious person infects five
Speaker 1: or eight other people. So if the equation for her
Speaker 1: immunity is one minus one of her are not, what
Speaker 1: that means exponential? That's right. It means we actually now
Speaker 1: need a higher percentage of people who are immune in
Speaker 1: order to stop the spread of the delta variant. So
Speaker 1: how big a threat are these reluctant vaxers or anti
Speaker 1: vaxers in that you know, Texas to Georgia, it's about
Speaker 1: eights to parts of eight states. Um, that really seemed
Speaker 1: to be when you look at a map of the country,
Speaker 1: that's the reddest both politically ends in terms of the
Speaker 1: lowest vaccination rate. Not a coincidence, but will hold that
Speaker 1: argument aside till later. How dangerous are these groups of
Speaker 1: unvaccinated people to themselves, to their friends and family, and
Speaker 1: to the rest of the country. Well, I think you know.
Speaker 1: And I get asked this question a lot around vaccine hesitancy,
Speaker 1: and it's one of the oldest issues in public health,
Speaker 1: and actually because back to Jacobson v. Massachusetts in nineteen
Speaker 1: o five, the right of the individual to decline vaccination
Speaker 1: versus the protection of the herd, the good of the whole.
Speaker 1: And we've dealt with this a lot in California, and
Speaker 1: I really understand vaccine hesitancy. And what I've told my
Speaker 1: friends and family who are hesitant to get the vaccine
Speaker 1: is stay down to my house. No, you don't just
Speaker 1: get vaccinated to protect yourself. You get vaccinated for the
Speaker 1: people that you love and the people that they love,
Speaker 1: and the people that they love. Because the situation. The
Speaker 1: reality is this, people have two choices. They can get
Speaker 1: vaccinated or they can get COVID with adulta variant that
Speaker 1: has an are not a five to eight. Those are
Speaker 1: their two choices. You get vaccinated and protected, or you
Speaker 1: are going to get COVID because this is spreading so rapidly.
Speaker 1: M that's quite horrifying. So what do you do with
Speaker 1: a person who basically says this whole thing is a hoax.
Speaker 1: Six thousand Americans didn't die, it's just like the flu.
Speaker 1: The President said that it will be gone like that.
Speaker 1: How do you respond to somebody who's been propagandized to
Speaker 1: that level. Yeah, I think it's a real challenge where
Speaker 1: politics and misinformation has, unfortunately um found its way into
Speaker 1: science messaging the way. You know, I struggle with it
Speaker 1: when I have those conversations with people. What we know
Speaker 1: from public health vaccine efforts in the past is that
Speaker 1: coming down with a hammer doesn't work. UM. It tends
Speaker 1: to uh, unless you're more literal than with an actual hammer.
Speaker 1: Coming out with the metaphorical hammer, yeah, it doesn't work.
Speaker 1: I think the caret works better, which is explaining to
Speaker 1: people that protect Grandma, that's right, protect Grandma. That's worked
Speaker 1: incredibly well in Mexico, which is a different set of
Speaker 1: cultural values than we have where the message of protect
Speaker 1: grandma really really works in the United States. What we
Speaker 1: know works more is protect the vulnerable children around you,
Speaker 1: protect the vulnerable people around you. So I don't know.
Speaker 1: I mean, it's a hard conversation with people that are
Speaker 1: vaccine hesitant today, but they need to understand that delta
Speaker 1: variant is spreading so quickly, and it's just the variant
Speaker 1: of the day. There will be a aditional variants that emerged.
Speaker 1: It's only the fourth letter. There's more common exactly. You
Speaker 1: know this, Uh. I trust the behavior of this virus
Speaker 1: far more than I trust the predictive behavior of people.
Speaker 1: Why pathogens do exactly what we know they'll do. I
Speaker 1: love studying pathage, I love outbreaks, I love winning competition.
Speaker 1: And they're going to get better and better at infecting
Speaker 1: their hosts because if they don't do that, there's a
Speaker 1: reason the delta variant is dominant. It's pushed aside the
Speaker 1: previous variants. That's right. The virus is going to mutate
Speaker 1: and it's going to spread, and it's going to mutate
Speaker 1: to spread. So of course we see a strain of
Speaker 1: the virus that spreads easier. It won't be the last strain.
Speaker 1: There will there will be more. It will continue to mutate.
Speaker 1: That's quite amazing. And what about the chip that Bill
Speaker 1: Gates is putting in the vaccine to track me and
Speaker 1: my iPhone? Which I always find hilarious. They're concerned about
Speaker 1: being tracked, but this literally tracks everywhere you've been. How
Speaker 1: do you respond to that sort of stuff? You know,
Speaker 1: my my fourteen year old and twelve year old. Every
Speaker 1: now and then we'll we'll send me some videos that
Speaker 1: they see circulating online that have conspiracy theories, and I
Speaker 1: watch them because I want to understand why people are
Speaker 1: scared and hesitant, and I think it's important not to
Speaker 1: discount their fears. At this point in the pandemic, people
Speaker 1: don't know who to trust, and instead of discounting them,
Speaker 1: the more interesting conversation to me is how might we,
Speaker 1: as one united country build the kind of system solution
Speaker 1: and leadership that a whole of society would trust, even
Speaker 1: if they have different political beliefs, you know, red and blue,
Speaker 1: extreme sides of the aisle. So I think it's really
Speaker 1: a systems failure of government institutions in this pandemic response,
Speaker 1: that we're at the point where people are so politicized
Speaker 1: that getting a vaccine or not, which is just pure science,
Speaker 1: is now made out to be full of conspiracy theories. Right.
Speaker 1: I saw a hilarious cartoon this weekend. If we would
Speaker 1: have had Fox News in the fifties, Um, we'd still
Speaker 1: be fighting polio, which is kind of kind of amusing. Um,
Speaker 1: let's move past vaccine hesitancy and talk a little bit
Speaker 1: about where we are today about whatever the next pandemic
Speaker 1: is going to be. Are we better equipped now than
Speaker 1: we were in to fight an upcoming pandemic or do
Speaker 1: we still have the same systemic problems that were revealed
Speaker 1: last year? We still have the same systemic problems. Look,
Speaker 1: the United States and companies and government have essentially duct
Speaker 1: taped together a response to COVID with individual vigilance and
Speaker 1: individual heroic efforts, but neither of those are an effective
Speaker 1: strategy in the long term for managing what we now
Speaker 1: know as an existential risk to the U S economy.
Speaker 1: And so if if a different pathogen threat were to
Speaker 1: occur today, we are no better are prepared. And that's
Speaker 1: what I'm really focused on again, not just for private sector,
Speaker 1: for government, but as a whole of society response. What
Speaker 1: are the systems solutions for the country to contain a
Speaker 1: fast moving, novel pathogen that occurs simultaneously across the US,
Speaker 1: and and so what can we do? What should we
Speaker 1: be doing? Well, there's a number of approaches UM. They
Speaker 1: certainly include UM intelligence, leveraging everything. All the technology that
Speaker 1: we have in Silicon Valley has not hit the public
Speaker 1: health system, and in disease control, largely the decisions and
Speaker 1: the operations are done manually or by individuals. I was
Speaker 1: the individual doing that, and so there's an incredible opportunity
Speaker 1: with Silicon Valley innovative technology to apply it to disease control.
Speaker 1: There's also the operational aspect of it, meaning looking at
Speaker 1: local public health health departments. They are the frontline generals.
Speaker 1: They're on the ground. You know, my job, is Michael
Speaker 1: describes in the book, was to control disease by all
Speaker 1: means necessary. So operationally as a country, I really think
Speaker 1: it's important that we rethink who's doing the frontline operations,
Speaker 1: do they have enough resources, and do we have a
Speaker 1: way to quickly get centralized intelligence out to all those people?
Speaker 1: Right now, the way they share information is fax machines
Speaker 1: and emails and phone calls, and that cannot move as
Speaker 1: fast as the pathogen. Well, I guess you can fight
Speaker 1: pandemics in the century with late twenty century technologies. That's right.
Speaker 1: The pathogens are moving faster, and so we have to
Speaker 1: develop systems that can move even faster than the pathogens.
Speaker 1: And you know what I was inspired by was watching
Speaker 1: Twitter and how fast rumors can spread on Twitter. Uh
Speaker 1: in January, That's where I was going to look for
Speaker 1: intelligence from. Yeah, I was watching you know, video feeds
Speaker 1: and information on social media, and I realized Twitter moves
Speaker 1: faster than the actual virus moves. Things go viral on
Speaker 1: Twitter faster than the virus goes viral. I'm gonna confirm
Speaker 1: what you said because I have a vivid recollection of
Speaker 1: when Osama bin Laden was killed by the U S
Speaker 1: Special Forces. That first was revealed to the public by
Speaker 1: some local who was describing what was happening on go
Speaker 1: back and recall that was the first confirmation about helicopters,
Speaker 1: about the soul going on. And then subsequently we we
Speaker 1: you know, everybody else put the pieces together. But yeah,
Speaker 1: the speed of Twitter Twitter is the new when they
Speaker 1: used to talk about in the stock market the tape.
Speaker 1: Twitter's new tape across is Twitter before crosses anything else. Yeah,
Speaker 1: you know, and even though it's oftentimes spreading misinformation, especially
Speaker 1: around things like vaccinations, um and and that's you know,
Speaker 1: something that we really need to address. The truth is
Speaker 1: the speed at which information goes viral on Twitter is
Speaker 1: what gave me hope that Silicon Valley technology can revolutionize
Speaker 1: disease control to move faster than the pathogen, because that
Speaker 1: kind of technology exists. So let's talk a little bit
Speaker 1: about your new venture, the Public Health Company. The mission
Speaker 1: is to protect business and communities from infectious disease. That's
Speaker 1: quite That's quite an aggressive mission, isn't it. Absolutely? And
Speaker 1: what inspired me leading the COVID response with Amazing Humans
Speaker 1: in California was that the private sector was experiencing what
Speaker 1: I had experienced as local health officer and a state
Speaker 1: health officer, and that is, no one's coming to save you.
Speaker 1: When there's a disease outbreak. You have limited intelligence, sketchy
Speaker 1: information from scattered sources, but you have to make an
Speaker 1: operational plan. And not making a decision is a decision.
Speaker 1: In other words, you're damned if you do and damned
Speaker 1: if you don't, and you've got to pick. And I
Speaker 1: was amazed how the private sector business is ran to
Speaker 1: the fight. They wanted to do everything they could to help,
Speaker 1: but they did not have the tools. They didn't have
Speaker 1: a public health department inside of them. Some of them
Speaker 1: had duct taped one together. And we're really left having
Speaker 1: transferred the risk management of infectious disease to local and
Speaker 1: state government who were overwhelmed by the pandemic. And so
Speaker 1: by may or June of I couldn't stand it anymore.
Speaker 1: I knew what needed to happen. I knew that Silicon
Speaker 1: Valley technology could revolutionize infectious disease risk management, and that
Speaker 1: the tools, the way that I thought about risk, and
Speaker 1: the differential diagnosis and the operational plan, all of that
Speaker 1: could be revolutionized by tech. And why weren't we putting
Speaker 1: that into scalable software? And honestly, there was nothing else
Speaker 1: I could do with my life, you know, by by
Speaker 1: July August than to launch that effort. And so really
Speaker 1: our mission at the Public Health Company is we are
Speaker 1: building those solution in technology to democratize access to risk
Speaker 1: management of infectious disease, so that private sector businesses, globally
Speaker 1: distributed enterprises that deal with infectious disease all the time,
Speaker 1: that they have that kind of expertise at their fingertips.
Speaker 1: So how is this set up? Is this going to
Speaker 1: be like a dot org or and a philanthropic organization.
Speaker 1: Are you setting it up like a consulting firm or
Speaker 1: do you want this to become a scalable technology and
Speaker 1: app that people can buy and used to manage their
Speaker 1: own um prevention of infectious diseases. We are developing software
Speaker 1: and as I looked at the very early applications we
Speaker 1: had developed, I got really excited because it had to
Speaker 1: do with genomic variants and how the virus mutates. And
Speaker 1: it's a concept called genomic epidemiology or I affectionately also
Speaker 1: call it genomic weather mapping. You know how you can
Speaker 1: look at a weather map and you can see the
Speaker 1: weather forecast and what's coming by region. So we can
Speaker 1: actually do that for variance of the virus and say,
Speaker 1: how is the delta variant different from the alpha variant
Speaker 1: and what does that mean for the state of Georgia
Speaker 1: or for a specific county. We can predict, you know,
Speaker 1: in a time stamped way, the likelihood that cases are
Speaker 1: going to go up or down. And not just for COVID,
Speaker 1: but these are the kinds of models that every local
Speaker 1: disease controller has to do in their head figuring out
Speaker 1: what's the direction of the mannincha cockle outbreak, for example.
Speaker 1: Michael Lewis tells that story in the book. So math
Speaker 1: and microbiology really is, you know, very simple data science modeling,
Speaker 1: codifying that into software and giving disease forecasting and then
Speaker 1: the answer to the question what do I do now
Speaker 1: based on it? Handing that to someone in a way
Speaker 1: that is simple, accessible at their fingertips is an incredible
Speaker 1: need and it doesn't exist. And it's for the private sector,
Speaker 1: it's for the public sector, it's for healthcare systems. We
Speaker 1: are creating some new not just with the technology platform,
Speaker 1: but a new sector of someone that you can pick
Speaker 1: up the phone and call when when there's an infectious
Speaker 1: disease threat. So what's the company going to look like
Speaker 1: in terms of a product. Will I be able to
Speaker 1: get an app on my phone and get alerts that hey,
Speaker 1: the region where you are is now showing an uptick
Speaker 1: of infections and take steps to protect yourself or is
Speaker 1: it going to be more for the private corporate sector.
Speaker 1: Tell us what the product is going to look like. Sure, well,
Speaker 1: I think the best way to explain it would be
Speaker 1: the analogy of cybersecurity. You know, there were some really
Speaker 1: high profile cyber attacks in two thousand ten, two thousand
Speaker 1: and eleven, and after that private enterprise realized, oh, this
Speaker 1: is a risk that we own. We own this potentially
Speaker 1: catastrophic risk to our enterprise, and so we have to
Speaker 1: have that capability running in the background, monitoring the risk
Speaker 1: that can ramp up or ramp down. And so the
Speaker 1: quietly humming machine in the background of cybersecurity is a
Speaker 1: perfect analogy to what we're creating because really, as a
Speaker 1: as a tech enabled service, we are scalable software, but
Speaker 1: we are humans behind it. I would argue the best
Speaker 1: humans in the world, you know um Carter, Measher and
Speaker 1: Jodorici from the book or advisers to the company. I
Speaker 1: talked to those guys every day. We're codifying that thinking
Speaker 1: in those tools into scalable software in a way that
Speaker 1: we can help a business in an ongoing way manage
Speaker 1: the risk the potential threats in all geographic regions. But
Speaker 1: then help them know how do what do we do
Speaker 1: practically tactically operationally for our business? Quite intriguing. So you're,
Speaker 1: for lack of a bit of where your logo is
Speaker 1: prevent detects contain explain what those three words mean in
Speaker 1: terms of providing a shield for the private sector or
Speaker 1: the public sect against an infectious outbreak. Sure, So I
Speaker 1: would start with explaining it by the most important skill
Speaker 1: is index of suspicion. So for any doctor or for
Speaker 1: any frontline public health officer, having an index of suspicion
Speaker 1: means you've gathered data from all the sketchy sources, maybe
Speaker 1: which are somewhat unreliable, but taken together, it gives you
Speaker 1: a sense of the direction things are headed. So that's
Speaker 1: infectious disease modeling and certainly can be codified into software.
Speaker 1: So being able to look at disease forecasting and predict
Speaker 1: what the potential threats are, having a plan of action
Speaker 1: of how you're going to prevent that from happening, and
Speaker 1: then being able to detect it. You know, testing, looking
Speaker 1: at the different capabilities we have from what we've seen
Speaker 1: in COVID is vast development of rapid tests. The rapid
Speaker 1: tests that have been developed by the private sector are
Speaker 1: incredible and are very very good. And then containment, you know,
Speaker 1: like I mentioned before, containment is where all the effort
Speaker 1: has to be for the government because the risk of
Speaker 1: failing at containment, as the United States did in means
Speaker 1: that then we have to make these awful choices, you
Speaker 1: know that impact the economy and impact health, and so
Speaker 1: for our clients, both government and private businesses. Really the
Speaker 1: value proposition is the ability to have disease forecasting, take
Speaker 1: action based on it, decrease your risk, and find that
Speaker 1: balance between continuity of operation and the health of your employees,
Speaker 1: the health of the community, and knowing that that brand
Speaker 1: has a safe environment. And from what I've read, this
Speaker 1: is more than just the germ of a startup idea.
Speaker 1: This is a real company that's funded, that has clients.
Speaker 1: Tell us a little bit about where you are in
Speaker 1: the growth curve of the public health company. Sure, well,
Speaker 1: my archetype is a public health official, right, That's what
Speaker 1: I had been my whole career, And I jumped from
Speaker 1: being a health official of a state the large estate
Speaker 1: UH to learning Silicon Valley in business and understanding the
Speaker 1: pain points of the private sector. And of governments and
Speaker 1: of healthcare systems and architecting a technology based solution. It
Speaker 1: has been an adventure. And what has happened is our
Speaker 1: partners in Silicon Valley have rallied behind the public health
Speaker 1: company and our seed funding was in the spring. I'm
Speaker 1: thrilled to have partnered with ven Rock. I was introduced
Speaker 1: to them by Todd Park, who's on our board of
Speaker 1: directors and was really a thought partner to me as
Speaker 1: I founded this company, and he introduced me to ven
Speaker 1: Rock because they are very thoughtful at the kind of
Speaker 1: partnerships that they have around tech enabled services and healthcare
Speaker 1: I T companies, and so it's been an incredible growth
Speaker 1: curve for me and learning curve. And we have about
Speaker 1: twenty employees right now at this point, actually as of recently,
Speaker 1: I believe the numbers about up to twenty five. We
Speaker 1: are growing and scaling fast to build out these capabilities
Speaker 1: in software and if memory serves. Vent Rock has been
Speaker 1: around for quite a while, haven't they, I believe, since
Speaker 1: the nineteen sixties. One of the older silicon companies. Yeah,
Speaker 1: they were one of the first, and you know, partnering
Speaker 1: with them has been incredible for me as a first
Speaker 1: time founder and first time CEO. I have a ton
Speaker 1: to learn, and doing that in partnership with someone who
Speaker 1: is so well versed in this and has a lot
Speaker 1: of experience has been incredible. And tell us a little bit.
Speaker 1: What is an index of suspicion? It sounds so so clandestine.
Speaker 1: What is an index of suspicion? An index of suspicion
Speaker 1: is if you told me I have a nineteen year
Speaker 1: old college kid that has Ninja cockle disease and lives
Speaker 1: in a fraternity, My next thought as well, I generally
Speaker 1: know how fraternity social behavior goes, and I know there's
Speaker 1: probably a lot of cross pollination, so I suspect there
Speaker 1: are grab a whiteboard and a pen twelve other cases
Speaker 1: currently that are undetected, and that immediately informs the action
Speaker 1: that I take. So an index of suspicion is having
Speaker 1: a strong situational awareness of the environment, knowing the pathogen
Speaker 1: and how it behaves, and then doing the math and
Speaker 1: microbiology to figure out very quickly what is the risk
Speaker 1: this is about to get really big, how contagious is
Speaker 1: this and how bad is the outcome for that disease?
Speaker 1: That's right, quite quite interesting, Uh, There's a quote from
Speaker 1: the book that I grabbed that I really liked, which
Speaker 1: was quote, what scares me the most is our ability
Speaker 1: to respond to a new pathogen, maybe one we've never
Speaker 1: seen before, or an old pathogen like influenza that's mutated.
Speaker 1: We know we have to be prepared for that. Are
Speaker 1: we prepared for that? I do not believe that we are,
Speaker 1: And that's what motivated me to launch the Public Health Company,
Speaker 1: because unless we have a technology platform that can move
Speaker 1: faster than the pathogen, we will never be prepared. Quite
Speaker 1: interesting and and frightening. So when you got the finished book,
Speaker 1: and then I want to circle back to how you
Speaker 1: met Michael. But when you got the finished book, what
Speaker 1: was it like reading about yourself? How surreal was that experience?
Speaker 1: You know, it was really painful because I'm a fairly
Speaker 1: private person. I've been a government official my whole career,
Speaker 1: and to see my life story in print in a
Speaker 1: book was shocking. And it's also really hard to read
Speaker 1: about yourself in print. That's kind of interesting. So let's
Speaker 1: circle back to the beginning. How did Michael Lewis find you?
Speaker 1: You know, he texted me randomly out of the blue,
Speaker 1: and I had never read a Michael Lewis book. I
Speaker 1: recognized his name. I was going to say, I assume
Speaker 1: you kind of know who he is, kind of. I
Speaker 1: recognized his name. I mainly knew who he was because
Speaker 1: my friend DJ Pittill had told me about the Fifth
Speaker 1: Risk and that process of being in the Fifth risk.
Speaker 1: And so wait, wait, let me just stop you here.
Speaker 1: Money Ball, the movies, money Ball, The blind Side, the
Speaker 1: Big Short, these were all pretty big movies. Certainly, The
Speaker 1: Big Short was a giant movie when it came out. No,
Speaker 1: not your cup didn't didn't catch you? Well, the Big
Speaker 1: Short was not a giant movie for internal medicine microbiology docs.
Speaker 1: So you know, let's just say I had seen The
Speaker 1: blind Side and I loved that movie, but certainly didn't
Speaker 1: remember who wrote the book. Should I be saying this publicly?
Speaker 1: You could say that I had never read a Michael
Speaker 1: Lewis book. I recognized his name, I mean because DJ
Speaker 1: Patil had told me about his experience being in the
Speaker 1: Fifth Risk. But you know, Michael texted me, and on
Speaker 1: that first phone call, I said, I'm happy to speak
Speaker 1: with you. I googled him. On that first phone call,
Speaker 1: he said who are you? And I said, what do
Speaker 1: you what do you mean? And he said, well, you
Speaker 1: know the Wolverines and read Dawn said to speak to
Speaker 1: Charity Dean and um, he'd contacted DJ and Todd Park
Speaker 1: and they said, talked to Charity Dean and then Joe
Speaker 1: Deesi at bio hub and said, he said, I've never
Speaker 1: heard of you, and I thought, well, okay, yeah, okay,
Speaker 1: that's fine. But it was a funny first conversation. In fact,
Speaker 1: it started off the first two minutes. I said, Michael,
Speaker 1: I know I don't know you, but I've got to
Speaker 1: make a fifty one forty nine decision. Have you ever
Speaker 1: had to make one of those? And he said, well,
Speaker 1: I'm making one right now. I'm deciding whether or not
Speaker 1: I'm going to write a book. And so we talked
Speaker 1: through the meaning you have a certainty and how brave
Speaker 1: are you going to be? Are you gonna pull the clip? Essentially, yeah,
Speaker 1: So we talked through the decision I was making and
Speaker 1: the decision he was making, And of course what I
Speaker 1: didn't know at the time is I think by the
Speaker 1: end of the conversation he had decided to write a
Speaker 1: book and I was going to be in it, and
Speaker 1: I had no clue, no clue about that, So what
Speaker 1: was the next step? So you you finished the conversation,
Speaker 1: you leave thinking, oh, so that seemed like an interesting guy.
Speaker 1: He leaves saying, Oh, I'm writing this book now. Meanwhile,
Speaker 1: the way he operates, he's already been assembling, he's been
Speaker 1: collecting characters, he's been lighting, writing vignettes all year. He
Speaker 1: sees a thread that connects all of these together, and
Speaker 1: suddenly there's a full narrative. What was the next step
Speaker 1: with him? How did he how did he proceed from
Speaker 1: there with you and and the rest of the characters
Speaker 1: in the book. Well, what I didn't know at that time,
Speaker 1: and he told me later, is before he even called me,
Speaker 1: he had an entire file with my name on it,
Speaker 1: everything I'd ever done, anything that was out there publicly
Speaker 1: about me. And it makes a ton of sense because
Speaker 1: as he asked me questions and you know, would come
Speaker 1: interview me and talk through how the public health system
Speaker 1: works from microbiology or my own story, Um, he already
Speaker 1: knew the answer to some of that about me, And
Speaker 1: so I think I think he was getting to know
Speaker 1: a potential character. I was clueless when he asked if
Speaker 1: I would be willing to be a character in the book. Um,
Speaker 1: I thought I was one of twenty. Maybe there'd be
Speaker 1: one or two lines from me. I never imagined I
Speaker 1: would be the protagonist. Not only are you the one
Speaker 1: of the key protagonists in the book, but the book
Speaker 1: begins with your story. That That was the surprise that
Speaker 1: you're the opening scene. It was a total surprise. I
Speaker 1: had no idea until I read the book, which was
Speaker 1: the day before I sat down with sixty Minutes. So
Speaker 1: I had no clue. And and yet I had made
Speaker 1: a decision in July of when he asked me to
Speaker 1: be a character in the book. I was either going
Speaker 1: to let him into my life or not. And I
Speaker 1: had been such a private person up to that point.
Speaker 1: But I don't have any secrets. It's a fairly vanilla
Speaker 1: life of a mom and a public servant. I'm gonna
Speaker 1: throw a yellow card on that one, but we'll circle
Speaker 1: back to it, because it clearly is not a vanilla life.
Speaker 1: You're basically calling governors and saying, hey, idiot, if you
Speaker 1: don't do this, you're gonna kill a lot of people.
Speaker 1: You need to you need to step up your game.
Speaker 1: That's not exactly dropping the kids off at soccer. Yeah. Well,
Speaker 1: to me, you know, I took my oath of office
Speaker 1: very seriously to protect and defend the United States against
Speaker 1: all threats for and in domestic and that includes pathogens.
Speaker 1: And so for me, it was always just fulfilling the
Speaker 1: oath that I took to protect communities by all means necessary. Well,
Speaker 1: it's good to see that some people still honor their
Speaker 1: oath of office. But we won't digress into that direction.
Speaker 1: Let's stick with the book, which by the way, is
Speaker 1: sitting on the credenza of my house where by the
Speaker 1: front door, where I was going to bring it with
Speaker 1: me to have you signed. Well, that means that we
Speaker 1: have to see each other again. I'll come back and
Speaker 1: sign it. I was gonna say, after we open up again,
Speaker 1: but we're kind of open up again. This just to
Speaker 1: digress a little bit. Not only is this the first
Speaker 1: time I'm in the Bloomberg building in a year and
Speaker 1: almost a year and a half, today was my first
Speaker 1: uh COVID test, right, And how was it? I know
Speaker 1: I'm here talking, so I assumed they wouldn't let me
Speaker 1: in the building without it. So you're having this conversation
Speaker 1: back and forth with him, not only are are you
Speaker 1: unaware of the fact that you're becoming the lead character
Speaker 1: in the book, but you're educating him on infectious disease.
Speaker 1: I know he's a quick learner and an in depth learner,
Speaker 1: but tell us a little bit about what that back
Speaker 1: and forth was like, you know it was. It was
Speaker 1: really painful at times. Um Dice basically spent a year
Speaker 1: teaching Michael is microbiology and public health disease control. And
Speaker 1: I took him on a tour of the places where
Speaker 1: some of those stories took place in Santa Barbara. So
Speaker 1: I took him to the homeless shelter, the coroner's office
Speaker 1: where the autopsy was done, which, by the way, again,
Speaker 1: that's an insane I hope that makes it into the
Speaker 1: movie if they make a movie. That's an insane scene
Speaker 1: in the book about you, Like, all right, you two
Speaker 1: idiot stopped falling around and outcomes the knife and you
Speaker 1: crack open the sternum and start pulling out internal organs,
Speaker 1: and the corner and his assistant stood there horrified. In
Speaker 1: the book, was that an accurate depiction of what was
Speaker 1: going on the way that Michael wrote it in the
Speaker 1: book was accurate? And what was funny about that scenario
Speaker 1: is I knew how risk averse and hesitant. Uh, the
Speaker 1: pathologist was to cut open her chest because of the
Speaker 1: fear that using a bone saw could theoretically there was
Speaker 1: one report in the literature spread aerisolized the tuberculosis bacteria,
Speaker 1: and so I understood the fear. But by the way,
Speaker 1: she's masked and has a full um face shield. Right
Speaker 1: when I showed up, everyone was wearing full ppe But
Speaker 1: I was the tuberculosis controller. I was. I had literally
Speaker 1: just been elected president of the California Tuberculosis Controllers Association.
Speaker 1: You never knew it existed. I was going to say,
Speaker 1: who even I was the president? That must be Those
Speaker 1: must be wild parties. They are super fun because we
Speaker 1: talk about things like drug resistant tuberculosis treatment. Sounds like fun.
Speaker 1: Does sound like a So TV doesn't scare me, you know.
Speaker 1: It's so you show up and you're like, I'll crack
Speaker 1: her open. I don't care. Like they thought they were
Speaker 1: intimidating you by saying you want those organs, you break
Speaker 1: her open. I think that they thought, and I should
Speaker 1: be careful here projecting what I think they thought. But
Speaker 1: I think my impression was if it was if they
Speaker 1: if I was going to issue a health offs or order,
Speaker 1: which I had, then it would have to be done
Speaker 1: under their terms, which was outside and that I couldn't
Speaker 1: be absent and not only had to be present, but
Speaker 1: had to be a very active participant. And what they
Speaker 1: didn't know is I had started out as a surgeon.
Speaker 1: I've done surgery for you know, some time in Africa,
Speaker 1: and I had been a general surgery resident at Cottage.
Speaker 1: I was super comfortable in the trauma bay cracking a
Speaker 1: chest open or you know, making fast decisions. And so
Speaker 1: what might have scared another doctor h to me was
Speaker 1: just Okay, so this is what we're doing today, Alright,
Speaker 1: let's go. It's really an amazing part of the book,
Speaker 1: and it sets the tone for who you are. It's like,
Speaker 1: you're not gonna you boys are not gonna look down
Speaker 1: at me and intimidate me because I know you show
Speaker 1: up your five foot nothing blond and these guys think
Speaker 1: they're going to run rough shot over you. Is that
Speaker 1: is that your life experience? I should be careful what
Speaker 1: I say here. No, you could say whatever you want
Speaker 1: to tell you. Listen, your life has already spread out
Speaker 1: in Michael Lewis's book, and he implied, you know, I'm
Speaker 1: following his lead. He implied as much that historically you
Speaker 1: were very much underestimated by the Boys Club and this
Speaker 1: was the perfect manifestation of that and the opportunity to say,
Speaker 1: my beer, watch this. You know, it's funny. So, uh,
Speaker 1: for those of us not here in this studio, I'm
Speaker 1: five ft four, I'm a solid hundred and fifteen pounds, solid, solid,
Speaker 1: long blonde hair. I always wear a suit and heels,
Speaker 1: and so I get that the way that I look
Speaker 1: projects a certain impression. And all my life, all my career,
Speaker 1: I've been in the house of medicine. The house of
Speaker 1: medicine feels like a fraternity at times. The boys Club
Speaker 1: evenlike finance, which you know, so even in medical school,
Speaker 1: you know, I went to med school at Tulane in
Speaker 1: New Orleans, and um, you know, the halls are lined
Speaker 1: with with photos and portraits of of men, and so
Speaker 1: as a woman, it feels like a very different game.
Speaker 1: And I figured out early on that in general, I
Speaker 1: was going to be assumed to be one type of person.
Speaker 1: And that's why I love trauma surgery. It's fast decisions,
Speaker 1: it's blood and guts, it's taking action. You're judged on
Speaker 1: what you actually do, and so I love that. So, yeah,
Speaker 1: Michael definitely locked onto that story as kind of an example,
Speaker 1: an archetypal example of what I had experienced throughout my career.
Speaker 1: And he wasn't wrong to say the very least. So
Speaker 1: so let's talk about a couple of things um from
Speaker 1: the book that I liked, that I thought was really interesting,
Speaker 1: and see if we can extrapolate forward to today. So
Speaker 1: I like the concept that measuring hospitalizations and deaths are
Speaker 1: a bit like starlight. You're dealing with the phenomena that
Speaker 1: has taken place long before. Everything that you're seeing in
Speaker 1: terms of data is ancient, because if someone's in the
Speaker 1: hospital today, it means they were infected ten, four, twenty
Speaker 1: one days ago or longer. What does this mean for
Speaker 1: detecting and containing infectious outbreaks? And secondly, what does it
Speaker 1: mean when you have an entity like the c d
Speaker 1: C that all they want is more data and the
Speaker 1: more data you get, the later you are in that
Speaker 1: containment curve. That's right, It's such a good point, which
Speaker 1: is basically, by design, a system or a thinker a
Speaker 1: human that can contain a fast moving novel pathogen by
Speaker 1: design has to operate in the setting of uncertainty. And
Speaker 1: the challenge with the CDC, and I include myself in
Speaker 1: this local and state public health departments, is that they've
Speaker 1: been or they they were created under an architecture to
Speaker 1: reward being risk averse to only act under certainty, to
Speaker 1: have a lot of data. The problem is, in an
Speaker 1: uncertain circumstance, not taking action is action. It means you
Speaker 1: lose your chance at containment and a worse outcome if
Speaker 1: if the numbers chake out that way, that's right. And
Speaker 1: so if you wait until you're certain, you've waited too long,
Speaker 1: you've lost your chance. And that's what we saw happen
Speaker 1: with COVID. There was no effort by CDC states I
Speaker 1: would say locals, but there really was an effort by
Speaker 1: some locals to contain this when when we had the chance.
Speaker 1: And the reason is that an institution that needs certainty,
Speaker 1: by definition, it will be too late, too late to act.
Speaker 1: So so let's talk about states. What states got it right,
Speaker 1: what states got it wrong, or if you want to
Speaker 1: be a little more circumspect, what were the actions taken
Speaker 1: that you thought were right and what were some of
Speaker 1: the actions taken that had adverse outcomes. I don't even
Speaker 1: know how to answer that, because we all got it wrong.
Speaker 1: Who got it less wrong? Who got it more wrong?
Speaker 1: I have tremendous respect for Governor Newsom in California. Every
Speaker 1: decision I saw him make was right. He wanted to
Speaker 1: understand the science, he wanted to understand the modeling, and
Speaker 1: he was brave and bold and leaned forward and led
Speaker 1: the country when he issued the stay at home order.
Speaker 1: What was hard about that is governors had a horrible
Speaker 1: choice where suddenly they were not being led at the
Speaker 1: federal level. They were not given any tools to test.
Speaker 1: They were basically told, you're on your own, no one's
Speaker 1: coming to save you. Does that sound familiar? Um? And
Speaker 1: so you know, the way that California led the country
Speaker 1: I absolutely believe was right. But I don't want to
Speaker 1: give anyone anymore than a D minus in this response.
Speaker 1: And that is a system's failure. In other words, like
Speaker 1: the humans got it right, the humans did exactly what
Speaker 1: they should have done with heroic efforts, but the system failed.
Speaker 1: The whole system failed. And so no matter how good
Speaker 1: a governor's leadership was or individual vigilance. It was it
Speaker 1: was going to be no match for this pathogen. What
Speaker 1: are your thoughts on school closing lockdowns? Because we from
Speaker 1: what we've learned about pandemic, that was very effective. When
Speaker 1: you look at Pennsylvania in Philadelphia versus Um, was it
Speaker 1: Cincinnati was the comparable state where city St. Louis versus Philadelphia.
Speaker 1: That was really an interesting comparison. And when you actually
Speaker 1: run the numbers, the faster UM lockdown was much more
Speaker 1: effective at containment. That's right. And the reason why it
Speaker 1: was more effective is what you had pointed out earlier
Speaker 1: that if you wait until you have deaths and hospitalizations,
Speaker 1: then you're too far behind. You haven't acted fast enough.
Speaker 1: So with the very first death, at the very first case,
Speaker 1: you have to act quickly. So you asked what I
Speaker 1: think about schools? Well, what I love about having met
Speaker 1: Carter Mesher and Richard Hatchett is they did not tell
Speaker 1: me through the whole time we're on phone calls, as
Speaker 1: as Wolverine's on the Red Don calls, they did not
Speaker 1: tell me that they had written the pandemic plan for
Speaker 1: the CDC under the Bush administration. They're so humble, but
Speaker 1: the premise of that is, they had gone back and
Speaker 1: re examined nineteen eighteen and discovered that the difference between St.
Speaker 1: Louis and Philadelphia was St. Louis lockdown sooner and prevented
Speaker 1: a number of deaths and bad outcomes. And so schools
Speaker 1: play a huge role. You know, with COVID, children are
Speaker 1: less likely to show symptoms. This is opposite than a
Speaker 1: century You go, right, that was a well, So the
Speaker 1: pathogen is different in that the Spanish flu of nineteen eighteen.
Speaker 1: Not to get too wonky here, but the death curve
Speaker 1: looked like a wright so very young were very fay girl,
Speaker 1: very young, but also twenty year old, so high spike
Speaker 1: and the children high spike year olds, and then high
Speaker 1: spike and the elderly. The difference with COVID is children
Speaker 1: are largely asymptomatic, but they absolutely still spread it. And
Speaker 1: so that was the logic behind closing down schools is
Speaker 1: children can spread it to each other. Uh, we did
Speaker 1: not have ample testing to detect that, and children can't
Speaker 1: be vaccinated. Right now, I think it's really important. You know,
Speaker 1: I have three kids and I homeschooled them for a
Speaker 1: year during COVID while running the COVID response, It was hard.
Speaker 1: I think getting kids back to school is critical. Kids
Speaker 1: need to be back to school. What does that mean
Speaker 1: all of us adults need to be vaccinated and tools
Speaker 1: like rapid tests and masking and decreasing the risk where
Speaker 1: we can, we need to implement that to make sure
Speaker 1: our kiddos can get back to school in the fall.
Speaker 1: Makes a lot of sense. Uh, what happened in cities
Speaker 1: where they cave to pressure from either business interests or
Speaker 1: political interests about reopening more quickly. What with the results
Speaker 1: of that? You mean now we're in nine team both. Well,
Speaker 1: that's the great St. Louis versus Philadelphia comparison from nineteen eighteen.
Speaker 1: And Philadelphia they move forward and had their parade as
Speaker 1: planned with thousands and thousands of people breathing and coughing
Speaker 1: on each other, and you know, a few weeks later
Speaker 1: it was a massacre of deaths in Philadelphia. And what
Speaker 1: we're about to see in the United States is what
Speaker 1: Carter Mesher calls a tale of two America's and I agree,
Speaker 1: meaning in communities that are under vaccinated, the delta variant
Speaker 1: is going to move very fast. Remember, restrictions have been
Speaker 1: lifted a lot of people are not masking. Congregate gatherings
Speaker 1: are taking place, and so we're about to see two America's,
Speaker 1: vaccinated America versus unvaccinated America. And I'm very, very concerned
Speaker 1: about the delta variant causing wreaking havoc in unvaccinated regions.
Speaker 1: Quite quite shocking. So so, like so many other of
Speaker 1: Michael Lewis's book, this book like looks like it's heading
Speaker 1: uh to be made as a major motion picture. If
Speaker 1: you could pick somebody to play you in the film,
Speaker 1: assuming they make a film, who would you pick? Because
Speaker 1: I have a couple of actresses I would I would
Speaker 1: think about like Natalie Portman or Claire Danes or there's
Speaker 1: a handful of people I think could take your role. Um,
Speaker 1: Julia Roberts already did Aaron Rockovic, so she's off the table.
Speaker 1: Who would you pick to play yourself? I am neutral.
Speaker 1: I don't have an opinion. Reese Witherspoon, that could be
Speaker 1: a good actress. What I told Universal Studios is I
Speaker 1: offer my support and help if I can be helpful
Speaker 1: to you anyway, and I I want to just be supportive.
Speaker 1: They are the artists. This is what they do. They're
Speaker 1: really good at it. I'm a nerdy public health doctor,
Speaker 1: so I think I'll let Hollywood do what it does.
Speaker 1: Come on, you know, there has to be someone you
Speaker 1: think would do a good job playing you. I'm neutral, alright,
Speaker 1: let me so I'm gonna throw a different curve ball
Speaker 1: at you. That's movie related. Let's talk a little bit
Speaker 1: about Star Wars. Oh, let's talk about stars looking for So.
Speaker 1: I have to assume you've been watching The Mandalorian, right
Speaker 1: I did. Have you watched any of the other animated
Speaker 1: features on Disney, like Rebels, Oh, I can't bring myself
Speaker 1: to do it, because some of them are really good.
Speaker 1: I'm a Star Wars purist. So I watched The Mandalorian
Speaker 1: because my my I have three boys, they're ten, twelve,
Speaker 1: and fourteen, and they begged me and convinced me to
Speaker 1: watch the man. It was great. It was good, but
Speaker 1: it's not a Star Wars. So the reason I love
Speaker 1: Star Wars is I first got interested in The Hero's
Speaker 1: Journey by Joseph Campbell, Man of a Thousand Faces, And
Speaker 1: when I discovered that Joseph Campbell had been a thought
Speaker 1: partner in designing Star Wars to be the classic heroes Journey.
Speaker 1: That's why I fell in love with Star Wars. So
Speaker 1: I haven't been able to watch any of the spinoffs. Yeah,
Speaker 1: but you watched all right, so if um you watched,
Speaker 1: obviously we all started with Star Wars and then Empire
Speaker 1: and then Jef Die. But then you know the episode
Speaker 1: the first couple sort of went off the rails after that,
Speaker 1: and it was only the most recent You want to
Speaker 1: talk about jaw Banks, that's scandalous. I so I love
Speaker 1: the pod race scene in episode one with Anakin as
Speaker 1: a little kiddo. That is one of my all time
Speaker 1: favorite stars. That's a good scene in a not great particular.
Speaker 1: I love that movie. The most recent few have been
Speaker 1: a huge improvement over the previous view. They're fantastic. And
Speaker 1: what I love about um, you know the first three.
Speaker 1: So if you look at Anakin Skywalker, Luke Skywalker, and
Speaker 1: certainly Ray, all of them are orphans in the desert
Speaker 1: who don't know who their family of origin is and
Speaker 1: they don't know what they're calling is. And I think
Speaker 1: that resonates with every human, you know, groping our way
Speaker 1: in the darkness to figure out who am I and
Speaker 1: what am I supposed to do? On Earth. I love
Speaker 1: how animated this this makes you. I can't get you
Speaker 1: off the fence on who should play you, Reese Witherspoon,
Speaker 1: give me a call, but Star Wars and you're just
Speaker 1: suddenly so I only have you for a few more minutes.
Speaker 1: Let me jump to my favorite questions that we ask
Speaker 1: all of our guests, and speaking of of Star Wars,
Speaker 1: tell us what you're streaming? What do you What are
Speaker 1: you when the boys watching during lockdown on Netflix or
Speaker 1: Amazon Prime besides the Mandalorian, Oh, I nothing, nothing. Um,
Speaker 1: that's not the answer you want. No, I don't. I'm
Speaker 1: just curious. It's answer. Yeah, it's listen. It's always a
Speaker 1: curiosity when you find out that someone who studies infectious
Speaker 1: disease love Star Wars. That sort of stuff is so
Speaker 1: honestly during lockdown, like your boys are not watching The Crown, No,
Speaker 1: they're not watching The Crown. The question over dinner is
Speaker 1: which Star Wars episode are you gonna watch? But you
Speaker 1: don't watch. It's been a year. You're not watching a
Speaker 1: different Star Wars every night, Episode seven about fifty six times,
Speaker 1: to the point that my kids say, over dinner, Mom,
Speaker 1: it's not episode seven. We're not watching that again, and
Speaker 1: so we we do watch Star Wars a lot. That's frightening. Yeah, um,
Speaker 1: all right, so let me let me go on, but
Speaker 1: it's Star Wars. Well, we watched The Mandaloriana. We watched
Speaker 1: Stranger Things. We repeated season one of Stranger Things because
Speaker 1: it's so good. We love Stranger Things. Um. I think
Speaker 1: that's it that we pretty much were pretty we stick
Speaker 1: to the same stuff. Yeah, um this, I'm gonna make
Speaker 1: a recommendation for you. But I'm drawing a blank on
Speaker 1: the name now, which is pretty awful, and I'll circle back.
Speaker 1: I also make them watch any movies about carbon. Did
Speaker 1: you see Altered Carbon? Altered Carbon? Now? It could be
Speaker 1: the best sci fi series I've seen this year. And
Speaker 1: that includes Well, The Boys might be a little too
Speaker 1: gross and violent for you. I don't know if that. Oh,
Speaker 1: we don't mind gross and violence. I generally I generally
Speaker 1: avoid you know, certain other categories. But gross and violent
Speaker 1: is Finally, there's some sexual stuff in it, but it's
Speaker 1: mostly just what happens if superheroes are corrupt corporate players.
Speaker 1: Is the theme on that. It's from a graphic novel,
Speaker 1: and if if If The Boys is a little too
Speaker 1: grizzly for you. Umbrella Academy was really interesting in the
Speaker 1: same orphan theme runs through that, as as Star Wars
Speaker 1: such is kind of interesting. There's a ton of really
Speaker 1: interesting sci fi that have come out but altered carbon.
Speaker 1: It's two seasons and it's just everybody I've recommended that too,
Speaker 1: has come back and said five stars. It's just so good. Okay, So,
Speaker 1: and I'm a Star Wars so I'm gonna tell you
Speaker 1: if I'm gonna make one wreck, that that's the one.
Speaker 1: Let's talk about your career a little bit. Who were
Speaker 1: some of your mentors that helped shape and guide your career.
Speaker 1: When I was at Tulane, I decided I wanted to
Speaker 1: do trauma surgery because I was working with Norm McSwain
Speaker 1: and Dr Norm McSwain was a famous trauma surgeon at
Speaker 1: Tulane and I absolutely adored him. And even though my
Speaker 1: path ended up twisting and turning into public health disease control,
Speaker 1: the way that I think about taking fast action, you know,
Speaker 1: cut the patient open, a lot of it goes back
Speaker 1: to Norm McSwain. The other mentor was doctor Steve Jose,
Speaker 1: who was an infectious disease doctor that Michael Lewis talked
Speaker 1: about in the book, and he trained me how to
Speaker 1: think about infectious disease. And so it's really the combination of,
Speaker 1: you know, the fast scalpel of a trauma surgeon with
Speaker 1: the critical risk management of an infectious disease doctor. That
Speaker 1: shaped how I manage outbreaks. Very interesting. Let's talk about books.
Speaker 1: What are some of your favorite books and what are
Speaker 1: you reading right now? Sure? Well, I'm reading a book
Speaker 1: by Ben Horrow. It's called The Hard Thing About Hard Things,
Speaker 1: and I absolutely love it. You know, I'm a new
Speaker 1: CEO and I'm learning and I'm learning fast, and so
Speaker 1: that book has really influenced my thinking around making hard
Speaker 1: decisions and doing them sooner. Uh. And I let's see
Speaker 1: what podcasts am I listening? Oh, the podcast I'm listening
Speaker 1: to is by Reid Hoffman, Masters of Scale. He interviews
Speaker 1: really interesting business leaders and actually met him last week
Speaker 1: for the first time, and so the Reid Hoffman podcast
Speaker 1: is really helpful to me to hear from other startup
Speaker 1: CEOs who ended up being very successful. What were their
Speaker 1: challenges and strategies in the very beginning. I'm trying to
Speaker 1: remember the name of Ben Horowitz is colleague Scott Poor,
Speaker 1: whose general counsel at UM Entrees and Horowitz, wrote a
Speaker 1: book on the Secret to Silicon Value of the Secret
Speaker 1: of Venture Capital, and it's really just a very smart,
Speaker 1: basic how to. Here's what you should know if you're
Speaker 1: setting up a company, if you're taking outside financing, and
Speaker 1: it's just written from someone from the inside. So if
Speaker 1: you like Ben's book, his colleague Scott's book is really
Speaker 1: what's interesting. I've kind of worked my way through UM
Speaker 1: half the A sixteen Z crew. They're they're really interesting guys. UM.
Speaker 1: Next question, what sort of advice would you give to
Speaker 1: a recent college grad who was interested in a career
Speaker 1: in either public health or infectious disease. I would ask
Speaker 1: them what they really want to do. Because of what
Speaker 1: they really want to do is change the world or
Speaker 1: protect communities, then they need to think hard about what
Speaker 1: their career path is because becoming a medical doctor, you know,
Speaker 1: my path was I went to medical school at the
Speaker 1: same time in parallel, doing a master's in public health
Speaker 1: and tropical medicine, then did general surgery, then did internal medicine.
Speaker 1: It is many, many years, and I would tell them
Speaker 1: to think long and hard about what's the endgame, what
Speaker 1: are they hoping to do? Because public health and medicine
Speaker 1: is not the only path to accomplishing what they want
Speaker 1: to I think people tend to think, oh, I need
Speaker 1: to become a doctor and or get a PhD in
Speaker 1: public health to make a difference, But there's lots of
Speaker 1: ways to make a difference that are not as long
Speaker 1: of a path. Interesting and our final question, what do
Speaker 1: you know about the world of public health today that
Speaker 1: you wish you knew twenty five or so years ago
Speaker 1: when you were first getting started? Sure, well, I'm forty
Speaker 1: three years old, so twenty five or so years ago
Speaker 1: would put me at what call years ago? Though? So
Speaker 1: when you were first thinking about public health and and
Speaker 1: what what insight do you have today might have helped you? Um,
Speaker 1: when you were just getting out of medical school. I
Speaker 1: wish I had known that I was just as smart
Speaker 1: that a poor kid from rural California, I'm sorry, a
Speaker 1: poor kid from rural Oregon that grew up on government
Speaker 1: assistance with parents that didn't have college degrees, could not
Speaker 1: only be just as successful, but could absolutely lead a
Speaker 1: public health department or lead an entire state. I didn't
Speaker 1: know that then. I was very intimidated by my classmates
Speaker 1: who came from wealthy families and ivy league colleges and
Speaker 1: I didn't. And that impostor syndrome has plagued me my
Speaker 1: whole career, and I still struggle with it. And today,
Speaker 1: you know, covid response to such a great example where
Speaker 1: what really matters is how brave someone is and how
Speaker 1: committed they are, and how much they persevere, not necessarily
Speaker 1: the privilege or their family of origin. But when you're
Speaker 1: twenty three years old you don't know that yet. That's
Speaker 1: quite interesting. Thank you, Charity for being so generous with
Speaker 1: your time. We have been speaking with Charity Dean. She
Speaker 1: is the co founder of the Public Health Company, as
Speaker 1: well as the protagonist of Michael Lewis's new book, The Premonition.
Speaker 1: If you enjoy this conversation, well, be sure and check
Speaker 1: out any of our previous UH three and fifty or
Speaker 1: so such podcasts that we've done over the past seven years.
Speaker 1: You can find those at iTunes, Spotify, wherever finer podcasts
Speaker 1: are found. We love your comments, feedback and suggestions right
Speaker 1: to us at m IB podcast at Bloomberg dot net.
Speaker 1: You can sign up from my Daily Reads at Ridolts
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Speaker 1: com slash Opinion. Follow me on Twitter at rit Halts.
Speaker 1: I would be remiss if I did not thank the
Speaker 1: crack staff that helps put this conversation together each week.
Speaker 1: Paris Wald is my producer. Charlie Wouldner is my audio engineer.
Speaker 1: A Tika val Bron is our project manager. Michael Batnick
Speaker 1: is my researcher. I'm Barry Hults. You've been listening to
Speaker 1: b STOOD Business on Bloomberg Radio.