WEBVTT - Coronavirus update: Why wasn't the U.S. better prepared? 0:00:00.400 --> 0:00:05.640 Hi everyone, I'm Katie Kuric, and welcome to next question. Today, 0:00:05.680 --> 0:00:08.559 we once again are dedicating our full attention to the 0:00:08.560 --> 0:00:13.760 coronavirus pandemic, which continues to spread across the country, growing 0:00:13.840 --> 0:00:17.840 at alarming rates in the most populated areas. In fact, 0:00:17.920 --> 0:00:21.400 on Friday, March, the Mayor of New York City, Bill 0:00:21.480 --> 0:00:26.360 de Blasio, marked a distressing new milestone. I hate to 0:00:26.480 --> 0:00:29.480 say this, but it's true. We are now the epicenter 0:00:29.600 --> 0:00:33.400 of this crisis. New York State has nearly half of 0:00:33.440 --> 0:00:37.720 the nation's coronavirus cases, and the number is growing faster 0:00:37.840 --> 0:00:42.280 than anyone predicted. As of this recording, the positive COVID 0:00:42.400 --> 0:00:46.520 nineteen count in New York City is doubling every three days. 0:00:47.000 --> 0:00:52.200 Here's Governor Andrew Cuomo. On March, one of the forecasters 0:00:52.200 --> 0:00:54.360 said to me, we were looking at a freight train 0:00:55.240 --> 0:00:58.480 coming across the country. We're now looking at a bullet train, 0:00:59.480 --> 0:01:02.800 because then numbers are going up that quickly. What that 0:01:02.880 --> 0:01:06.039 means is that the peak of coronavirus infections will be 0:01:06.120 --> 0:01:09.560 much higher and hit New York much sooner than expected. 0:01:09.959 --> 0:01:13.759 Giving the city's vast network of hospitals, which are already 0:01:13.840 --> 0:01:18.160 under tremendous strain, less time to prepare, less time to 0:01:18.200 --> 0:01:21.200 get the critical equipment they need to care for those patients, 0:01:21.600 --> 0:01:25.399 and less time to replenish their stash a protective gear 0:01:25.800 --> 0:01:30.160 so that medical staff can continue to work without getting sick, 0:01:32.360 --> 0:01:35.880 Which leads to my next question, how are emergency rooms 0:01:35.880 --> 0:01:38.840 in New York City faring now? And how are they 0:01:38.920 --> 0:01:43.280 bracing for what's to come? And later on what could 0:01:43.280 --> 0:01:46.080 have been done to allow us to be better prepared 0:01:46.200 --> 0:01:54.760 for this pandemic. But first, Hi, rob Hi, Hi, it's Katie. 0:01:54.800 --> 0:01:58.120 How are you? How are you doing? Oh? My god? 0:01:58.200 --> 0:02:01.760 Thank you for taking time to do. Dr Robert Semia 0:02:02.080 --> 0:02:04.520 is the Chair of Emergency Medicine IT and y you 0:02:04.640 --> 0:02:07.480 Land Gown in New York City. In that role, he's 0:02:07.480 --> 0:02:10.880 in charge of the emergency departments of several n y 0:02:11.000 --> 0:02:16.079 U hospitals across the metropolitan area. We see about five 0:02:16.480 --> 0:02:20.560 thousand patients in all of our emergency departments across Manhattan, Brooklyn, 0:02:20.639 --> 0:02:24.440 and Long Island, and we've seen a couple of consistent things. 0:02:24.600 --> 0:02:30.000 One Overall, at the majority of our emergency departments, the 0:02:30.200 --> 0:02:35.240 volume is down, but we have a huge spike in 0:02:35.280 --> 0:02:40.160 the number of respiratory cases that are serious requiring requiring intubation, 0:02:40.520 --> 0:02:43.480 and that numbers seems to be growing every day. I 0:02:43.480 --> 0:02:46.120 get a I get a report every twelve hours from 0:02:46.120 --> 0:02:50.120 our emergency departments Shift report one of our a d s. Yesterday, 0:02:50.160 --> 0:02:54.320 in a twelve hour period intubated seven patients had put 0:02:54.320 --> 0:02:57.240 them on ventilators. That's a huge number for one twelve 0:02:57.240 --> 0:02:59.520 hour period of time. And then you know we have 0:02:59.680 --> 0:03:01.600 very The next day might be one or two. The 0:03:01.639 --> 0:03:03.840 next day it might be six or seven again, so 0:03:03.919 --> 0:03:07.920 there's capacity right now, but everyone's trying to figure out 0:03:08.520 --> 0:03:11.000 how do you make sure that there's capacity down the road. 0:03:11.880 --> 0:03:14.760 To help with some of this, we stood up a 0:03:16.080 --> 0:03:21.200 twenty four hour a day video visit telemedicine, where now 0:03:21.240 --> 0:03:26.320 we're seeing a thousand visits on a telemedicine platform trying 0:03:26.320 --> 0:03:30.000 to keep people off the subways from spreading disease, giving 0:03:30.000 --> 0:03:33.359 them advice, and keeping them out of the emergency departments. 0:03:33.360 --> 0:03:37.160 So we have seen some good impact there where our 0:03:37.240 --> 0:03:40.080 overall eat volume is down for people that are not 0:03:40.160 --> 0:03:42.840 seriously ill, but we have seen a huge spike in 0:03:42.880 --> 0:03:45.960 the number of people who are very sick and needing 0:03:45.960 --> 0:03:48.800 to be put on ventilators. Well, let's first talk about 0:03:48.840 --> 0:03:53.920 the telemedicine patients rob you're seeing. Basically, they need to 0:03:53.960 --> 0:03:56.480 know if their symptoms are serious enough to go to 0:03:56.560 --> 0:04:00.200 the hospital, if they in fact have COVID nineteen. In 0:04:00.320 --> 0:04:03.800 most of those cases, are you able to encourage them 0:04:03.840 --> 0:04:06.920 to in fact stay at home and to self quarantine. 0:04:08.720 --> 0:04:12.080 We have. One of the things that the telemedicine visits 0:04:12.120 --> 0:04:15.840 that we're seeing is that there's a lot of public 0:04:15.880 --> 0:04:20.080 fear and it's grounded in in really a lack of information, 0:04:20.880 --> 0:04:24.080 and so we're seeing many patients who really have a 0:04:24.080 --> 0:04:27.240 couple of questions. One, they want to know if they're 0:04:27.240 --> 0:04:30.840 going to get seriously ill suddenly and die. Number two, 0:04:30.920 --> 0:04:33.880 they want to know if they need a test for COVID. 0:04:34.440 --> 0:04:37.400 And number three they want to know, Okay, what symptoms 0:04:37.440 --> 0:04:40.760 do I watch for if I quarantine at home. When 0:04:40.800 --> 0:04:44.599 someone calls you, particularly an elderly person, and worries that 0:04:44.600 --> 0:04:48.120 that person is going to be come extremely ill from this, 0:04:48.240 --> 0:04:50.719 what do you tell them? The majority of calls that 0:04:50.760 --> 0:04:53.880 we're seeing are from people that are younger that have 0:04:54.520 --> 0:04:57.640 symptoms that most of us, if it wasn't this pandemic, 0:04:57.640 --> 0:05:02.000 would think our typical winter rest the tory colts, low 0:05:02.040 --> 0:05:06.480 grade fever, cough um right, no sore throat. The issue 0:05:06.520 --> 0:05:09.240 is that those symptoms overlap with the same symptoms as 0:05:09.279 --> 0:05:12.360 COVID and UM. What I tell patients is that most 0:05:12.440 --> 0:05:15.720 of us will probably are many of us will probably 0:05:15.760 --> 0:05:18.520 get COVID and UM not even realize that. We'll just 0:05:18.560 --> 0:05:20.760 think at the winter cold and the majority of us 0:05:20.800 --> 0:05:23.840 will do just fine. UM. And really the people that 0:05:23.960 --> 0:05:26.880 need to go to the e r s are those 0:05:27.240 --> 0:05:30.000 who have those typical resttory symptoms and then those symptoms 0:05:30.000 --> 0:05:33.560 progress to UM shortness of breath and difficulty in breathing, 0:05:34.160 --> 0:05:36.680 and so we give them advice about that, and we 0:05:36.720 --> 0:05:40.160 also talk about the need for testing. And for most patients, 0:05:40.200 --> 0:05:42.680 what we tell them is, you know, if your symptoms 0:05:42.720 --> 0:05:45.440 are in that minimal group right now, you're not having 0:05:45.920 --> 0:05:50.000 shortness of breath. Whether you have a COVID test or not, 0:05:50.320 --> 0:05:54.200 does not change the information and the guidance that I'm 0:05:54.240 --> 0:05:55.960 going to give you right now, which is to stay 0:05:55.960 --> 0:06:01.400 at home self quarantine um UH. Go to the CDC 0:06:01.600 --> 0:06:04.360 or the government websites. UM. If you're unsure about the 0:06:04.400 --> 0:06:06.400 best way to self quarantine at home. We usually tell 0:06:06.440 --> 0:06:09.039 people you should do things like if you share a 0:06:09.040 --> 0:06:11.280 bedroom with someone, to sleep in a separate bedroom, if 0:06:11.279 --> 0:06:14.880 you have a second bathroom, try to use that bathroom, 0:06:15.600 --> 0:06:19.960 do good disinfection of counter surfaces, and those things. And 0:06:19.960 --> 0:06:21.680 then we give them guidance about what you need to 0:06:21.720 --> 0:06:24.720 watch for, and that being the increasing shortness of breath 0:06:24.839 --> 0:06:27.359 and for those patients, you should come to the emergency department. 0:06:27.839 --> 0:06:31.560 Most people are pretty relieved when they hear that because 0:06:31.680 --> 0:06:34.200 they're just not sure. The experience that we're seeing in 0:06:34.200 --> 0:06:37.839 the emergency department is that the majority of the patients 0:06:37.880 --> 0:06:42.000 that are ending up on rest but on ventilators are elderly, 0:06:42.480 --> 0:06:45.520 but we are seeing people in younger age groups that 0:06:45.560 --> 0:06:49.160 are very sick. Also. I'll tell you what's been the 0:06:49.240 --> 0:06:52.800 uplift thing part of these conversations is that we're seeing 0:06:52.839 --> 0:06:57.240 many people that are younger generations that are sick, and 0:06:57.279 --> 0:06:59.279 they're telling me, you know, I don't want to go 0:06:59.360 --> 0:07:02.960 out and potentially infect older people, and I don't want 0:07:03.040 --> 0:07:06.160 my grandmother and my grandparents to be at risk, and 0:07:06.240 --> 0:07:09.600 so um, that part has been very uplifting to to hear. 0:07:10.040 --> 0:07:13.360 So it's that's positive because we've seen so many stories 0:07:13.480 --> 0:07:18.000 rob of of kids going on spring break and being irresponsible. 0:07:18.160 --> 0:07:20.960 So it's nice to hear that younger people are actually 0:07:21.640 --> 0:07:25.520 thinking otherwise than trying to be more responsible. Let's talk 0:07:25.560 --> 0:07:29.440 about personal protective equipment or PPE, a word that the 0:07:29.520 --> 0:07:32.960 general population now understands that used to be the purview 0:07:33.000 --> 0:07:36.760 of the medical community. We're talking about the mass, the gowns, 0:07:36.800 --> 0:07:41.600 the gloves that protect you and your team from coronavirus. UM. 0:07:41.640 --> 0:07:46.160 Are you all getting the equipment you need? There's not 0:07:46.280 --> 0:07:51.880 enough and UM we have the equipment now, but we're 0:07:51.880 --> 0:07:54.480 worried that UM, as is everybody that will run out, 0:07:55.000 --> 0:08:00.080 and so we started conservation measures that are safe, but 0:08:00.200 --> 0:08:04.960 they're psychologically taxing on the doctors and nurses at work. 0:08:05.640 --> 0:08:09.560 So UM. Some of the things that we've done UM 0:08:09.720 --> 0:08:13.760 are to cohort any patient that comes into emergency departments 0:08:14.120 --> 0:08:17.000 into just one area of the e er. Whereas before 0:08:17.040 --> 0:08:19.960 all this happened, you you know, we have multiple teams 0:08:19.960 --> 0:08:22.360 and we have big emergency departments, and you could go 0:08:22.400 --> 0:08:24.720 to any part of the emergency department. Now we we 0:08:24.800 --> 0:08:28.640 put all the patients in one area that have those symptoms, 0:08:29.760 --> 0:08:33.080 and in that area are doctors and nurses where those 0:08:33.160 --> 0:08:36.040 and nine masks that you're probably hearing about and those 0:08:36.040 --> 0:08:40.280 masks are in short supply. And and how those masks 0:08:40.320 --> 0:08:44.240 help is they help with airborne or or virus that's 0:08:44.559 --> 0:08:47.679 floating in the air, and typically they're used for tuberculosis 0:08:47.760 --> 0:08:51.600 or things like that. COVID appears to be mostly droplets, 0:08:51.600 --> 0:08:53.920 so somebody sneezes on you, costs on you. Those that 0:08:54.000 --> 0:08:56.880 liquid hits you, um and doesn't really hang in the air, 0:08:56.920 --> 0:08:59.280 but there are some indications that for certain things it 0:08:59.280 --> 0:09:01.040 does hang in the air, like when we're doing an 0:09:01.040 --> 0:09:05.600 intubation or those things. So, UM, what we've had to 0:09:05.600 --> 0:09:10.640 do is to somewhat limit how many times we change 0:09:10.679 --> 0:09:14.000 out of that equipment, so you might wear your same 0:09:14.080 --> 0:09:18.959 mask with a face shield, for example, on the entire shift, 0:09:19.800 --> 0:09:23.640 instead of changing it multiple times to shift. We do 0:09:23.760 --> 0:09:26.440 change our gowns and other things. Or if we get sprayed, 0:09:26.679 --> 0:09:30.199 of course we change. But that's something that we never 0:09:30.280 --> 0:09:33.160 had to do. We never had to worry about conservation 0:09:33.679 --> 0:09:38.840 and UM, to an im introom doctor or nurse, it's 0:09:38.840 --> 0:09:43.600 it's an emotional drain. Um. You're already in a in 0:09:43.679 --> 0:09:48.200 a and basically a space suit that you can only 0:09:48.280 --> 0:09:51.520 change up part of it. You're hot, you're sweaty. Yeah, 0:09:51.640 --> 0:09:55.480 everybody's concerned that. You know, can the supply and chain 0:09:55.640 --> 0:09:58.920 catch ups? Anybody who works with you have any of 0:09:58.960 --> 0:10:05.240 your colleagues got sick? Yes, Um, so many of our 0:10:05.280 --> 0:10:09.720 people have gone sick. Doctors and nurses with fevers or costs. 0:10:10.040 --> 0:10:14.880 We they all get sent home. When COVID testing was available, 0:10:14.920 --> 0:10:18.520 they were tested, some of them positive, some negative. The 0:10:18.559 --> 0:10:20.560 good news is all of all of our people who 0:10:20.640 --> 0:10:24.000 actually have been positive and sick are all better and 0:10:24.160 --> 0:10:28.400 return to work. Now we've done some things. We do 0:10:28.520 --> 0:10:33.920 have some more senior physicians. We've kept them uh in 0:10:34.000 --> 0:10:37.440 parts of the emergency department where they're not exposed, you know, 0:10:37.559 --> 0:10:41.200 just knowing that that most people that have a little 0:10:41.240 --> 0:10:43.720 more candles on their birthday cake are more at risk. 0:10:44.280 --> 0:10:46.520 But no, the good news is is at n y 0:10:46.640 --> 0:10:49.000 U Land going here, every every one of our doctors 0:10:49.520 --> 0:10:53.480 and nurses that's gotten sick has recovered us fine. I 0:10:53.520 --> 0:10:55.560 want to bring up a question from a listener. Her 0:10:55.600 --> 0:10:58.360 name is Mary, she's a nurse. She doesn't say where 0:10:58.400 --> 0:11:00.880 she works, but she wondered if how care workers should 0:11:00.880 --> 0:11:05.000 isolate themselves from their families. I'm assuming even if they're 0:11:05.240 --> 0:11:09.679 asymptomatic if and if so, how have you gotten such 0:11:09.679 --> 0:11:14.880 a question yourself? What are you advising your colleagues to do? So? 0:11:15.160 --> 0:11:18.679 One of the things is that, UM, you know, just 0:11:18.760 --> 0:11:23.199 like the general public. UM. You know, our colleagues and 0:11:23.200 --> 0:11:26.680 the emergency departments UM here in New York and across 0:11:26.720 --> 0:11:29.439 the country come to work every day. But everybody has 0:11:29.480 --> 0:11:33.960 their own anxieties about this, and so for example, UM, 0:11:34.120 --> 0:11:37.840 we've created the ability for people to shower before they 0:11:37.840 --> 0:11:39.800 actually go home because they're wondering, am I going to 0:11:39.880 --> 0:11:43.400 spread something? Am I an asymptomatic career? I have people 0:11:44.120 --> 0:11:46.199 that I work with who have decided they have a 0:11:46.200 --> 0:11:48.439 little baby at home, and with their seeing they pan 0:11:48.520 --> 0:11:50.240 out there that they're not going to go home, They've 0:11:50.320 --> 0:11:51.920 got a friend's place to stay at, who has a 0:11:52.000 --> 0:11:55.160 vacant apartment, of those kind of things. All those questions 0:11:55.200 --> 0:11:58.600 we run we run by our infection disease specialists. But 0:11:58.640 --> 0:12:01.839 I think you know a lot of people, even when 0:12:01.840 --> 0:12:04.560 they're doing the best practices at home, whether that's trying 0:12:04.600 --> 0:12:06.920 to keep a distance, even though they may not have 0:12:06.960 --> 0:12:10.240 any UM symptoms, they're still wondering. They're still worried for 0:12:10.280 --> 0:12:13.720 themselves and their word, for their family, and so they're 0:12:13.760 --> 0:12:19.520 taking whether it's appropriate, precautions, extra precautions. Yeah, people worry 0:12:19.520 --> 0:12:23.840 about those things and they try to keep some distance. UM. 0:12:23.920 --> 0:12:26.600 When I do these videos is it's also sides working 0:12:26.600 --> 0:12:28.920 in the dy we do get people. Another group that 0:12:28.920 --> 0:12:31.800 we're concerned about is if you live with somebody who's 0:12:31.800 --> 0:12:35.480 immuno compromised. You know, I've had people tell, you know, 0:12:35.800 --> 0:12:40.280 talk to me saying, you know, they can't get COVID 0:12:40.600 --> 0:12:44.400 testing as of today. Um. That seems to be constantly 0:12:44.440 --> 0:12:48.560 changing the availability of public testing. They're concerned because someone 0:12:48.559 --> 0:12:51.920 they live with has multiple miloma or some form of cancer. 0:12:52.800 --> 0:12:56.440 They're aware that those people are at an increase risk, 0:12:56.520 --> 0:12:58.800 and so they want to do the right thing. Try 0:12:58.880 --> 0:13:01.880 to keep their distance, try to socially isolate, but try 0:13:01.920 --> 0:13:04.319 to do that while you're sharing a home with somebody. 0:13:04.480 --> 0:13:06.440 I had people tell me they're living in their basement 0:13:06.480 --> 0:13:09.280 if they have a basement. Um. So there's a lot 0:13:09.360 --> 0:13:13.840 going on, um as people try to keep each other 0:13:13.880 --> 0:13:16.920 as safe as possible. When you think about the next 0:13:16.960 --> 0:13:20.280 few weeks, do you have any idea when this is 0:13:20.320 --> 0:13:25.160 going to peak? No idea, I don't you know, I 0:13:25.160 --> 0:13:31.120 don't know. UM, you know, it's hard hard to say, UM, 0:13:31.559 --> 0:13:36.040 I'm seeing sicker patients and in increasing numbers. I don't 0:13:36.080 --> 0:13:39.719 know when that will level off. Our general approach is 0:13:41.200 --> 0:13:42.680 that we need to be prepared for this to be 0:13:42.720 --> 0:13:45.440 a marathon and not a sprint, and so making sure 0:13:45.520 --> 0:13:49.480 that our doctors and nurses get adequate respite, making sure 0:13:49.520 --> 0:13:53.480 that we have relief physicians and nurses available should it, 0:13:53.679 --> 0:13:56.200 should much of the workforce go down temporarily or have 0:13:56.280 --> 0:14:00.560 to go home because they're sick. For approaches, UM do 0:14:00.640 --> 0:14:02.960 our best on a day to day basis, but our 0:14:03.040 --> 0:14:06.360 eyes looking down the road always tell people that you know, 0:14:06.440 --> 0:14:09.720 working in an emergency department on a regular day is 0:14:09.760 --> 0:14:14.640 like running a two minute no huddle offense in football, 0:14:14.679 --> 0:14:18.280 but for eight hours. And now you throw in, UM, 0:14:18.360 --> 0:14:22.000 some uncertainty into that mix. It's it's like you're trying 0:14:22.000 --> 0:14:24.960 to do that in a swimming pool. But UM, people 0:14:25.000 --> 0:14:29.000 that work in emergency departments are special. They have big hearts, 0:14:29.680 --> 0:14:34.840 They feel for patients and human suffering, and UM are 0:14:34.880 --> 0:14:38.520 really up for this challenge and and just want to know. 0:14:39.160 --> 0:14:41.880 I just want to feel that their support for them, 0:14:41.960 --> 0:14:47.720 and that support looks like proper ppe and UM, I 0:14:47.760 --> 0:14:50.520 will tell you that doing some of these videos. Its 0:14:50.560 --> 0:14:54.600 also has been uplifting because so many times people have 0:14:54.680 --> 0:14:58.960 expressed gratitude for what e R doctors and nurses do. 0:14:59.560 --> 0:15:02.640 We're getting more thank you than we normally do. We're 0:15:02.680 --> 0:15:07.840 seeing young people talk about how they're worried about older folks, 0:15:07.840 --> 0:15:12.120 and there's this multigenerational kind of commitment and kindness and 0:15:12.120 --> 0:15:18.200 empathy that's on display. So, UM, yeah, you know, we're 0:15:18.400 --> 0:15:22.120 all as a nation going through a lot, and we're 0:15:22.120 --> 0:15:25.640 all in this together. But I've seen some really encouraging 0:15:25.680 --> 0:15:29.920 signs of um, what the future looks like and um 0:15:30.160 --> 0:15:33.480 seeing a lot of people's in her kindness right to 0:15:33.560 --> 0:15:38.160 the surface, and that makes me feel really good. That 0:15:38.280 --> 0:15:41.400 was Dr Robert Famiett, Chair of Emergency Medicine at and 0:15:41.440 --> 0:15:45.280 why you land gone in New York City and why 0:15:45.360 --> 0:15:48.520 you may be managing now, but other hospitals around New 0:15:48.600 --> 0:15:52.400 York City and indeed the country are already struggling under 0:15:52.400 --> 0:15:55.520 the pressure of the coronavirus and the weeks to come. 0:15:55.560 --> 0:15:58.000 I'll be continuing to reach out to those working on 0:15:58.080 --> 0:16:00.880 the front lines of this pandemic, and I'll bring you 0:16:00.880 --> 0:16:04.640 those stories here on this podcast, also on Instagram. Live, 0:16:04.960 --> 0:16:07.880 which you can find by searching my name Katie Curic 0:16:08.120 --> 0:16:14.720 on Instagram. Up next, why wasn't this country better prepared? 0:16:15.240 --> 0:16:18.440 We'll talk with an expert whose job was to do 0:16:18.560 --> 0:16:37.400 just that. Welcome back, everyone. We're continuing our coverage of 0:16:37.440 --> 0:16:42.120 the coronavirus this week, taking a look at pandemic preparedness 0:16:42.600 --> 0:16:47.160 from the emergency room to the oval office. Hi, fa Hi, 0:16:47.200 --> 0:16:49.680 thanks so much for doing this. Beth Cameron is the 0:16:49.720 --> 0:16:53.760 former Senior Director for Global Health Security and Bio Defense. 0:16:54.160 --> 0:16:56.480 This unit, which was a part of the White House 0:16:56.560 --> 0:17:01.800 National Security Council, was established by the Obama administration after 0:17:01.840 --> 0:17:06.040 the two thousand fourteen Ebola epidemic, and it was intended 0:17:06.080 --> 0:17:09.080 to be a smoke alarm, a warning of the first 0:17:09.119 --> 0:17:13.640 signs of a global health crisis. In two thousand eighteen, however, 0:17:14.000 --> 0:17:18.320 the Trump administration disbanded the unit. The Office of Global 0:17:18.320 --> 0:17:20.840 Health Security and Bio Defense was set up after the 0:17:20.840 --> 0:17:24.879 Ebola epidemic in order to get ahead of outbreaks before 0:17:24.920 --> 0:17:29.200 they become epidemics or pandemics. We're really worried coming out 0:17:29.240 --> 0:17:32.879 of Ebola. It was a hugely devastating outbreak that killed 0:17:32.880 --> 0:17:35.919 over eleven thousand people. UM, but we were looking at 0:17:35.960 --> 0:17:40.000 that as ultimately an event that stayed relatively circumscribed to 0:17:40.400 --> 0:17:43.400 three major countries. Of course, there were lots of concerns 0:17:43.400 --> 0:17:46.000 that it would spread more rapidly, and there was a 0:17:46.080 --> 0:17:49.160 huge global intervention that the US helped lead to keep 0:17:49.160 --> 0:17:52.200 that from happening. But we were very worried about exactly 0:17:52.200 --> 0:17:56.600 what we're seeing now, a large scale respiratory illness that 0:17:56.640 --> 0:17:59.160 would become a pandemic, and we knew that we weren't 0:17:59.200 --> 0:18:02.199 prepared for that as a nation or as a world. 0:18:02.760 --> 0:18:05.240 Let's imagine a world in which that office had not 0:18:05.400 --> 0:18:09.080 been dissolved and you were still leading at Beath. What 0:18:09.240 --> 0:18:12.360 role would it be playing right now in the midst 0:18:12.720 --> 0:18:16.280 of this crisis. It would really be the best way 0:18:16.320 --> 0:18:18.800 to describe the office's role now would be as a 0:18:18.840 --> 0:18:22.960 coordinating hub. So the office was playing a role in 0:18:22.960 --> 0:18:27.520 in working with high level senior officials and sending information 0:18:27.680 --> 0:18:30.560 about problems and issues up the chain so that they 0:18:30.560 --> 0:18:34.080 would be resolved quickly. But also really importantly, we're listening 0:18:34.119 --> 0:18:38.120 to staff at the working level across departments and agencies. 0:18:38.119 --> 0:18:40.760 So when there was a problem or a challenge or 0:18:40.800 --> 0:18:44.320 a need in the States or in another country. We 0:18:44.320 --> 0:18:46.679 were able to figure out, Hey, what's the real issue, 0:18:46.760 --> 0:18:51.120 who's not agreeing, and then elevate it really quickly. You 0:18:51.200 --> 0:18:57.120 helped transition the incoming Trump administration. You directly briefed then 0:18:57.240 --> 0:19:01.680 Homeless Security Advisor Tom Bossard. Did you have a sense 0:19:01.720 --> 0:19:05.399 at that time the new administration was committed to the 0:19:05.480 --> 0:19:11.120 objectives of this office. Yes, during the transition, I had 0:19:11.240 --> 0:19:15.560 quite a good experience with transitioning this specific office from 0:19:15.560 --> 0:19:19.080 President Obama to President Trump, and both the outgoing team 0:19:19.160 --> 0:19:22.960 and the incoming team, particularly as you mentioned, Homeland Security 0:19:23.000 --> 0:19:27.399 Advisor Tom Basser had been through um pandemic threats before 0:19:27.520 --> 0:19:29.760 in the Bush administration, and so there's actually quite a 0:19:29.760 --> 0:19:32.880 lot of support for continuing the role of this office, 0:19:33.520 --> 0:19:36.000 and not only from Tom Basser, but also from National 0:19:36.000 --> 0:19:39.280 Security Advisor HR McMaster, who I briefed before I left. 0:19:40.119 --> 0:19:43.520 You said you were mystified when the Trump administration dissolved 0:19:43.560 --> 0:19:46.800 the office in May of two thousand eighteen. Now there 0:19:46.800 --> 0:19:50.720 seems to be a difference of opinion here with your 0:19:50.840 --> 0:19:53.760 op ed in the Washington Post and someone within the 0:19:53.760 --> 0:19:58.480 Trump administration name Tim Morrison, who believes that your account 0:19:58.560 --> 0:20:03.320 was wrong. So tell me as you understand it. What happened? 0:20:03.600 --> 0:20:06.960 Can you explain? I can, and and I think that 0:20:07.040 --> 0:20:09.600 Tim's op ed was less of a rebuttal of what 0:20:09.640 --> 0:20:12.560 I said and more of an explanation of the organizational 0:20:12.600 --> 0:20:16.600 structure UM and what happened. So my understanding of what 0:20:16.720 --> 0:20:20.320 happened is that Tim Zeemer, who took my position as 0:20:20.320 --> 0:20:23.399 the head of the Office UM, left the White House 0:20:23.560 --> 0:20:27.040 and the people who worked on his team were dissolved 0:20:27.200 --> 0:20:31.600 and were moved into another director at the director that 0:20:31.640 --> 0:20:36.080 Tim Morrison ran. And it's definitely true that some good 0:20:36.080 --> 0:20:40.080 policies did come out of that office following the dissolution 0:20:40.280 --> 0:20:44.240 of the pandemics team. But the difference, the critical difference, 0:20:44.320 --> 0:20:47.040 is that there wasn't a team or a senior level 0:20:47.440 --> 0:20:52.360 person whose only responsibility it was to handle pandemic threats. 0:20:52.880 --> 0:20:55.280 And that was something that coming out of the BOWLA 0:20:55.359 --> 0:20:59.200 Epidemic re realized was missing. That we were all focused 0:20:59.240 --> 0:21:02.120 on epidemic, we were all focused on the BOWLA outbreak, 0:21:02.400 --> 0:21:04.719 but we didn't have a singular mission with a direct 0:21:04.760 --> 0:21:08.320 reporting line to the National and Homeland Security Advisor where 0:21:08.320 --> 0:21:11.120 our job was only to focus on that issue. And 0:21:11.320 --> 0:21:15.359 it's like a transnational threat like counter terrorism um, like 0:21:15.520 --> 0:21:18.880 climate change, it's something that when we see what's happening now, 0:21:18.920 --> 0:21:21.359 it's easy to understand why you'd want to have a 0:21:21.440 --> 0:21:25.399 singularly focused pandemics team. But when you don't have a 0:21:25.440 --> 0:21:28.960 pandemic happening, I can see how it would how a 0:21:29.040 --> 0:21:31.840 national security advisor might look at that and think, well, 0:21:31.880 --> 0:21:34.679 maybe we don't need a team that's solely focused on 0:21:34.720 --> 0:21:37.600 this issue, and I just completely disagree with that. This 0:21:37.720 --> 0:21:40.679 is a lesson that lots of administrations have learned. So 0:21:40.720 --> 0:21:43.720 there have been senior level officials in the last couple 0:21:43.760 --> 0:21:47.560 of administrations focused on pandemic threats, and usually it's after 0:21:47.680 --> 0:21:51.200 an outbreak or a pandemic when that lesson um is learned. 0:21:51.240 --> 0:21:53.119 And so one of the things that happened in the 0:21:53.119 --> 0:21:56.639 Obama administration is a couple of lessons came together. One 0:21:56.720 --> 0:21:59.040 of those lessons was that we needed a senior level 0:21:59.080 --> 0:22:01.800 official who's only job it was with a direct reporting 0:22:01.840 --> 0:22:04.840 line to leadership. The other lesson is that we needed 0:22:04.840 --> 0:22:09.040 a team that looked at homeland and national security issues together. 0:22:09.560 --> 0:22:12.920 When President Trump was asked about this Beth during one 0:22:12.960 --> 0:22:15.720 of the White House press conferences, he insisted he didn't 0:22:15.760 --> 0:22:19.520 know anything about that, But you did disband the White 0:22:19.520 --> 0:22:22.919 House Pandemic Office, and the officials that were working in 0:22:22.960 --> 0:22:26.280 that office left this administration abruptly, So what responsibility do 0:22:26.320 --> 0:22:28.439 you take to that? And the officials that worked in 0:22:28.440 --> 0:22:30.400 that office said that you that the White House lost 0:22:30.480 --> 0:22:33.560 valuable time because that office wasn't disbanded. What do you 0:22:33.560 --> 0:22:35.960 make of that? Well, I just think it's a nasty 0:22:36.040 --> 0:22:40.440 question we've done. Were you surprised at that and who 0:22:40.480 --> 0:22:43.320 exactly was in charge of getting rid of the position? 0:22:44.320 --> 0:22:47.680 I was surprised by that. Um. I was surprised because 0:22:47.680 --> 0:22:50.320 there was quite a lot of press about getting rid 0:22:50.320 --> 0:22:53.320 of the office in when it happened, and there were, 0:22:53.359 --> 0:22:56.040 you know, a number of high level people in Congress, 0:22:56.400 --> 0:22:59.080 UM think tanks who wrote letters or spoke out and 0:22:59.119 --> 0:23:01.640 said that this was a mistake. So I was surprised 0:23:01.640 --> 0:23:05.000 that he wasn't aware. Um. The all I can say 0:23:05.119 --> 0:23:08.480 is that the dissolution of the office happened around the 0:23:08.520 --> 0:23:11.639 same time that Tom Bosser left, so right after he 0:23:11.720 --> 0:23:15.240 left and right as National Security Advisor John Bolton came 0:23:15.280 --> 0:23:18.040 on board, and so I think this really was part 0:23:18.119 --> 0:23:21.800 of an overall restructuring and a decision was made that 0:23:21.880 --> 0:23:25.040 this reorganization was a was a better organization for the 0:23:25.080 --> 0:23:28.240 White House. The White House is to choose its organizational structure. 0:23:28.280 --> 0:23:31.560 But it's unfortunate that this lesson got unlearned in the process. 0:23:32.200 --> 0:23:35.720 Let's talk about some of the warning signs though, that 0:23:35.840 --> 0:23:41.200 existed for this current epidemic pandemic. Rather, can you talk 0:23:41.280 --> 0:23:46.000 about some of the flashing red lights that we saw 0:23:46.240 --> 0:23:50.200 because there were a number of them, weren't there. Yeah, 0:23:50.240 --> 0:23:52.639 there were a number of them. Um, you know, going 0:23:52.680 --> 0:23:56.199 back to the beginning and watching the outbreak unfold in China, 0:23:56.920 --> 0:24:01.400 looking at a novel coronavirus that had um the ability 0:24:01.440 --> 0:24:04.840 to spread between people. That was definitely something in our 0:24:04.960 --> 0:24:08.640 playbook of concerns, you know, a new disease that could 0:24:08.680 --> 0:24:12.680 spread more quickly between people with with a higher mortality. 0:24:12.720 --> 0:24:16.000 And I think the second that that information became available, 0:24:16.040 --> 0:24:19.119 that would have flipped a switch for us to start 0:24:19.160 --> 0:24:23.000 meeting more regularly and thinking about what kinds of what 0:24:23.119 --> 0:24:25.800 kinds of preparedness plans we needed to put in place 0:24:25.880 --> 0:24:29.359 or dust off in the United States. And when was that? 0:24:29.359 --> 0:24:32.200 That was in January when those cases really started coming 0:24:32.400 --> 0:24:34.800 coming to light. There was absolutely a bit of a 0:24:34.840 --> 0:24:37.960