1 00:00:15,396 --> 00:00:23,916 Speaker 1: Pushkin from Pushkin Industries. This is Deep Background, the show 2 00:00:23,956 --> 00:00:27,436 Speaker 1: where we explore the stories behind the stories in the news. 3 00:00:27,996 --> 00:00:33,316 Speaker 1: I'm Noah Feldman. Throughout the long run of this pandemic, 4 00:00:33,716 --> 00:00:37,716 Speaker 1: we've been running episodes to keep you our listeners informed 5 00:00:38,156 --> 00:00:42,116 Speaker 1: about the latest changes in the emerging science of COVID, nineteen, 6 00:00:42,796 --> 00:00:47,716 Speaker 1: treatments appropriate to it, and public health responses available for 7 00:00:47,836 --> 00:00:50,596 Speaker 1: dealing with it. As the country has gone through a 8 00:00:50,716 --> 00:00:55,196 Speaker 1: substantial third wave of the virus, and as hospitals, especially 9 00:00:55,276 --> 00:00:59,396 Speaker 1: in the Southeastern United States, are coming dangerously close to capacity, 10 00:00:59,716 --> 00:01:01,836 Speaker 1: we thought it was the right time to have another 11 00:01:01,876 --> 00:01:05,876 Speaker 1: conversation about this topic, and particularly on what looks like 12 00:01:05,956 --> 00:01:08,596 Speaker 1: it will emerge as the new normal in the wake 13 00:01:08,676 --> 00:01:12,556 Speaker 1: of the variant. Here to discuss this with me today 14 00:01:12,796 --> 00:01:16,476 Speaker 1: is doctor Susan Philip. She is the health officer for 15 00:01:16,516 --> 00:01:19,556 Speaker 1: the City and County of San Francisco. I wanted to 16 00:01:19,556 --> 00:01:22,876 Speaker 1: talk with her in particular because San Francisco's COVID response 17 00:01:22,956 --> 00:01:25,996 Speaker 1: is in many ways a model for major American cities. 18 00:01:26,476 --> 00:01:30,716 Speaker 1: Nearly eighty percent of the eligible population is fully vaccinated there. 19 00:01:31,076 --> 00:01:34,276 Speaker 1: Just last week, San Francisco made news by becoming the 20 00:01:34,356 --> 00:01:37,476 Speaker 1: first big city in the us to require proof of 21 00:01:37,596 --> 00:01:44,036 Speaker 1: vaccination to get into restaurants, gyms, recreation centers, or any 22 00:01:44,036 --> 00:01:46,956 Speaker 1: event at all with more than a thousand people. Doctor 23 00:01:46,956 --> 00:01:49,876 Speaker 1: Philip wields the power to write health orders for the city. 24 00:01:50,276 --> 00:01:53,196 Speaker 1: She's been at the front lines of determining the right 25 00:01:53,276 --> 00:01:58,396 Speaker 1: policy responses to the challenges of the current moment. Doctor Phillip, 26 00:01:58,476 --> 00:02:05,156 Speaker 1: thank you so much for being here. I'm really looking 27 00:02:05,196 --> 00:02:09,756 Speaker 1: forward to delving deeply into the complex po see questions 28 00:02:09,756 --> 00:02:12,836 Speaker 1: that you're managing every day and your very important job. 29 00:02:13,756 --> 00:02:15,796 Speaker 1: To start the conversation, I thought we should try to 30 00:02:15,836 --> 00:02:18,636 Speaker 1: just do some level setting on the state of play 31 00:02:18,636 --> 00:02:22,996 Speaker 1: of the science, recognizing that this is a moving target 32 00:02:23,116 --> 00:02:25,236 Speaker 1: and that science is not an exact science when it's 33 00:02:25,316 --> 00:02:28,556 Speaker 1: constantly getting data at every given moment. But I want 34 00:02:28,556 --> 00:02:31,876 Speaker 1: to start by asking you about the Israel data that 35 00:02:31,956 --> 00:02:36,996 Speaker 1: seemed to suggest the need for booster shots at least 36 00:02:36,996 --> 00:02:40,556 Speaker 1: for people sixty and over and potentially for more people, 37 00:02:41,316 --> 00:02:45,316 Speaker 1: and how you think about that question of boosters interacting 38 00:02:46,036 --> 00:02:50,196 Speaker 1: with the broader question of the different variants delta and beyond. 39 00:02:50,716 --> 00:02:52,556 Speaker 1: Thank you and thank you very much for having me 40 00:02:52,716 --> 00:02:56,556 Speaker 1: today to speak with you. So you know, the news 41 00:02:56,596 --> 00:03:00,276 Speaker 1: coming out of Israel, and science just recently that shows 42 00:03:00,316 --> 00:03:04,116 Speaker 1: that a proportion of their hospitalized patients are are actually 43 00:03:04,156 --> 00:03:07,356 Speaker 1: fully vaccinated is concerning, and I think that goes along 44 00:03:07,396 --> 00:03:10,996 Speaker 1: with the data that ADC and other agencies in the 45 00:03:11,076 --> 00:03:14,676 Speaker 1: US have shared that really is more of the step 46 00:03:14,756 --> 00:03:18,876 Speaker 1: before that looking at immunologic response and seeing that decline 47 00:03:18,996 --> 00:03:23,036 Speaker 1: over time in some of these post approval studies of 48 00:03:23,076 --> 00:03:26,316 Speaker 1: people that have been vaccinated, and I think those together 49 00:03:26,516 --> 00:03:30,876 Speaker 1: are leading to this conversation about boosters and when we 50 00:03:30,956 --> 00:03:33,836 Speaker 1: do those in the United States and what that looks like, 51 00:03:33,876 --> 00:03:35,876 Speaker 1: and that of course raises a whole set of other 52 00:03:35,956 --> 00:03:39,556 Speaker 1: questions about the timing of doing that as opposed to 53 00:03:39,716 --> 00:03:42,756 Speaker 1: getting first doses to as many people as possible. But 54 00:03:43,196 --> 00:03:46,876 Speaker 1: that data seems to be increasingly clear that over time 55 00:03:47,476 --> 00:03:51,116 Speaker 1: there does seem to be a decrease antibody response immune 56 00:03:51,156 --> 00:03:54,636 Speaker 1: response that, at least in Israel, such a very highly 57 00:03:54,716 --> 00:03:59,276 Speaker 1: vaccinated country, we're seeing translate into some cases and certainly 58 00:03:59,316 --> 00:04:02,876 Speaker 1: hospitalizations and some of their population. And the reason I'm 59 00:04:02,876 --> 00:04:05,796 Speaker 1: asking about that is that if it were not for this, 60 00:04:06,236 --> 00:04:08,516 Speaker 1: it would be possible to frame the discussion rightly or 61 00:04:08,516 --> 00:04:11,476 Speaker 1: wrongly by saying, well, look, as soon as we can 62 00:04:11,476 --> 00:04:14,516 Speaker 1: get as large a number of people as possible vaccinated. 63 00:04:15,196 --> 00:04:18,316 Speaker 1: We can take on board that variance aside, we're just 64 00:04:18,316 --> 00:04:19,836 Speaker 1: going to get back to normal, and then what we're 65 00:04:19,836 --> 00:04:24,196 Speaker 1: basically debating is how fast, how slowly, what's the appropriate step. 66 00:04:24,796 --> 00:04:28,396 Speaker 1: But it may be that this data suggests that it 67 00:04:28,436 --> 00:04:29,716 Speaker 1: is not going to be as simple as that, that 68 00:04:29,756 --> 00:04:32,036 Speaker 1: we're going to have to have rolling vaccinations even for 69 00:04:32,076 --> 00:04:35,716 Speaker 1: those who are vaccinated, in order to avoid substantial amounts 70 00:04:35,716 --> 00:04:40,396 Speaker 1: of breakthrough infection. So seen through that lens, now let's 71 00:04:40,436 --> 00:04:43,156 Speaker 1: turn to sort of the incredible complexity that is your 72 00:04:43,196 --> 00:04:45,996 Speaker 1: day to day life with the judgments that you have 73 00:04:46,076 --> 00:04:50,156 Speaker 1: to make. Where do you currently stand in San Francisco 74 00:04:50,916 --> 00:04:57,996 Speaker 1: on public places and access to those public places? Well, 75 00:04:58,036 --> 00:05:02,156 Speaker 1: in San Francisco we do know that as everywhere, that 76 00:05:02,276 --> 00:05:04,996 Speaker 1: vaccination is going to be the key, if not to 77 00:05:05,036 --> 00:05:08,596 Speaker 1: getting back to full normalcy, at least to getting to 78 00:05:08,636 --> 00:05:11,996 Speaker 1: a place where fewer people are getting infected and we're 79 00:05:12,036 --> 00:05:14,716 Speaker 1: preserving the ability of our health system to take care 80 00:05:15,116 --> 00:05:18,556 Speaker 1: of people that need care for anything COVID nineteen or otherwise. 81 00:05:19,036 --> 00:05:22,716 Speaker 1: So in San Francisco, as of Friday, we have a 82 00:05:22,796 --> 00:05:26,196 Speaker 1: health order that went into effect that requires that in 83 00:05:26,276 --> 00:05:29,716 Speaker 1: indoor settings where food or drink are served, or in 84 00:05:29,756 --> 00:05:34,716 Speaker 1: any type of fitness establishment, gyms, other recreation facilities, if 85 00:05:34,756 --> 00:05:38,196 Speaker 1: they're indoors, people have to show proof of a full 86 00:05:38,276 --> 00:05:42,316 Speaker 1: vaccination to access those spaces, and we also have that 87 00:05:42,396 --> 00:05:45,196 Speaker 1: in place for any gatherings that are of a thousand 88 00:05:45,236 --> 00:05:48,356 Speaker 1: people or more. So these are some of the ways 89 00:05:48,356 --> 00:05:51,036 Speaker 1: in which we have a very high vaccination rate in 90 00:05:51,076 --> 00:05:53,676 Speaker 1: San Francisco, but these are ways in which we want 91 00:05:53,716 --> 00:05:58,236 Speaker 1: to encourage others to get vaccinated in order to access 92 00:05:58,316 --> 00:06:01,796 Speaker 1: these spaces that we know are higher risk. Throughout the 93 00:06:01,836 --> 00:06:04,596 Speaker 1: pandemic in the United States and worldwide, we've seen that 94 00:06:04,636 --> 00:06:07,396 Speaker 1: these indoor spaces are among those that are highest risk 95 00:06:07,516 --> 00:06:11,116 Speaker 1: or transmission led you to the conclusion, and I'm sure 96 00:06:11,156 --> 00:06:14,236 Speaker 1: this is a complex conclusion that includes both scientific elements 97 00:06:14,276 --> 00:06:18,796 Speaker 1: and policy judgments that places that don't primarily serve food 98 00:06:18,796 --> 00:06:24,156 Speaker 1: and drink, like workplaces for example, would not be logically 99 00:06:24,316 --> 00:06:28,316 Speaker 1: included in this current round of orders. You know, early 100 00:06:28,396 --> 00:06:31,236 Speaker 1: on and throughout the pandemic, some of the news that 101 00:06:31,276 --> 00:06:35,196 Speaker 1: came from the CDC, from the Morbidity and Mortality Weekly Report, 102 00:06:35,556 --> 00:06:39,396 Speaker 1: which is their journal CDC puts out, really showed in 103 00:06:40,076 --> 00:06:43,276 Speaker 1: rigorous case control studies where people are interviewed after they 104 00:06:43,316 --> 00:06:46,876 Speaker 1: become positive, what their activities may have been in the 105 00:06:46,916 --> 00:06:49,796 Speaker 1: weeks leading up to their testing positive, and then compared 106 00:06:49,836 --> 00:06:51,636 Speaker 1: to a group of people that tested at the same 107 00:06:51,676 --> 00:06:55,196 Speaker 1: time but tested negative. Really showed that the areas that 108 00:06:55,236 --> 00:07:00,676 Speaker 1: I mentioned restaurants, bars, gyms, were among those most associated 109 00:07:00,756 --> 00:07:05,196 Speaker 1: statistically associated with becoming positive. These sites are places that 110 00:07:05,276 --> 00:07:08,876 Speaker 1: by definition, people are removing their face coverings, they are 111 00:07:08,916 --> 00:07:12,156 Speaker 1: in contact with other people outside of their household, and 112 00:07:12,196 --> 00:07:15,756 Speaker 1: so there are more aerosols, more virus particles in the 113 00:07:15,796 --> 00:07:19,596 Speaker 1: air in restaurants, in bars, and you add into that 114 00:07:19,676 --> 00:07:23,076 Speaker 1: in bars and some other restaurants, it's loud, it's crowded, 115 00:07:23,156 --> 00:07:26,876 Speaker 1: people are leaning in closer to each other, and also 116 00:07:27,036 --> 00:07:31,196 Speaker 1: with the addition of drinking and alcohol, people are talking louder, 117 00:07:31,316 --> 00:07:36,316 Speaker 1: maybe more disinhibited talking to other people. So that explains 118 00:07:36,316 --> 00:07:38,076 Speaker 1: a little bit about why the risk might be there 119 00:07:38,076 --> 00:07:41,636 Speaker 1: in bars and restaurants. For fitness establishments, those have also 120 00:07:41,676 --> 00:07:45,636 Speaker 1: been associated in several studies from across the country in 121 00:07:46,516 --> 00:07:50,836 Speaker 1: outbreaks and increases, and there it's really again recognizing it's 122 00:07:50,876 --> 00:07:55,916 Speaker 1: a respiratory aerosol transmitted virus that people's respiratory rates are up, 123 00:07:56,116 --> 00:07:58,956 Speaker 1: they're breathing heavily, they're in an enclosed room with others, 124 00:07:59,236 --> 00:08:02,836 Speaker 1: and that's why we see that elevated risk. Let's talk 125 00:08:02,876 --> 00:08:06,476 Speaker 1: about the mechanisms that you might use to check that 126 00:08:06,556 --> 00:08:10,316 Speaker 1: people have been vaccinated. As I understand it right now, 127 00:08:10,676 --> 00:08:15,476 Speaker 1: you would accept the physical vaccination card. I'm imagining you 128 00:08:15,476 --> 00:08:17,916 Speaker 1: would also accept someone's picture on their phone or their 129 00:08:17,996 --> 00:08:21,876 Speaker 1: vaccination card or something similar to that. Have you, as 130 00:08:21,916 --> 00:08:27,276 Speaker 1: a city yet flirted with vaccine passports or other mechanisms 131 00:08:27,316 --> 00:08:31,036 Speaker 1: that might potentially be more reliable than a rather flimsy 132 00:08:31,076 --> 00:08:34,356 Speaker 1: piece of cardboard or a photograph of said flimsy piece 133 00:08:34,356 --> 00:08:37,676 Speaker 1: of cardboard. You know, we have not talked about San 134 00:08:37,676 --> 00:08:41,716 Speaker 1: Francisco having its own version of New York's excelsure pass 135 00:08:42,276 --> 00:08:45,196 Speaker 1: or anything like that. We do know that there are 136 00:08:45,476 --> 00:08:49,476 Speaker 1: private companies and others who have been working on these, 137 00:08:49,556 --> 00:08:51,956 Speaker 1: and so what we're trying to do is evaluate which 138 00:08:51,996 --> 00:08:55,836 Speaker 1: of those would also be acceptable for businesses to use 139 00:08:55,876 --> 00:08:59,236 Speaker 1: in San Francisco. For instance, the state also it's not 140 00:08:59,316 --> 00:09:02,596 Speaker 1: a full vaccine passport, but what they have done is 141 00:09:02,636 --> 00:09:06,636 Speaker 1: they allow people to access the state Immunization Registry and 142 00:09:06,756 --> 00:09:10,076 Speaker 1: get on their phone a QR code and so their 143 00:09:10,196 --> 00:09:13,276 Speaker 1: name and their dates of their vaccinations. One of the 144 00:09:13,316 --> 00:09:16,316 Speaker 1: topics that is widely discussed but is not so widely 145 00:09:16,316 --> 00:09:20,276 Speaker 1: discussed in the media, is the possibility of people falsifying 146 00:09:20,876 --> 00:09:23,876 Speaker 1: vaccination records. Right. I mean, in the world of things 147 00:09:23,876 --> 00:09:26,316 Speaker 1: that are hard to copy, and there are many in 148 00:09:26,356 --> 00:09:29,516 Speaker 1: our world, your vaccination proof is not one of them. 149 00:09:29,916 --> 00:09:33,916 Speaker 1: So somebody who wanted to spend ten minutes falsifying proof 150 00:09:33,916 --> 00:09:38,476 Speaker 1: of vaccination presumably could do that extremely easily, and there 151 00:09:38,476 --> 00:09:42,396 Speaker 1: would be absolutely no way for anyone to tell if 152 00:09:42,476 --> 00:09:44,236 Speaker 1: that were the case, or not to say nothing of 153 00:09:44,876 --> 00:09:47,356 Speaker 1: the person that a restaurant puts at the door, you know, 154 00:09:47,396 --> 00:09:49,956 Speaker 1: the greeter whose job is now includes not only being 155 00:09:50,036 --> 00:09:51,196 Speaker 1: nice to you and telling you how long the weight 156 00:09:51,316 --> 00:09:55,236 Speaker 1: is going to be, but also checking your proof of vaccination. So, 157 00:09:55,716 --> 00:09:58,756 Speaker 1: given that how much of what you're doing is sort 158 00:09:58,756 --> 00:10:01,236 Speaker 1: of a signaling function to try to send to the 159 00:10:01,316 --> 00:10:05,436 Speaker 1: public the feeling that you and San Francisco really expect 160 00:10:05,516 --> 00:10:08,436 Speaker 1: people to be vaccinated, how much of it is you 161 00:10:08,476 --> 00:10:11,196 Speaker 1: just calculate people are so moral that they would never 162 00:10:11,236 --> 00:10:14,436 Speaker 1: lie about such a thing. How much you calculated people 163 00:10:14,476 --> 00:10:16,156 Speaker 1: can't be bothered to do that, and it would just 164 00:10:16,156 --> 00:10:18,316 Speaker 1: be easier for them to go and get vaccination than 165 00:10:18,356 --> 00:10:21,956 Speaker 1: it would be to mess with a PDF. What's the 166 00:10:22,196 --> 00:10:24,516 Speaker 1: as it were, actual thinking behind this, if you're willing 167 00:10:24,596 --> 00:10:28,436 Speaker 1: to share it, sure, yes, I think that the way 168 00:10:28,476 --> 00:10:31,276 Speaker 1: I have always thought about it, the health orders themselves 169 00:10:31,316 --> 00:10:34,316 Speaker 1: are not enough to make the full impact. The health 170 00:10:34,396 --> 00:10:38,316 Speaker 1: orders are important, but they're not sufficient. So the way 171 00:10:38,356 --> 00:10:40,716 Speaker 1: we have always addressed this in San Francisco from the 172 00:10:40,756 --> 00:10:44,356 Speaker 1: beginning is to be very visible, to make sure that 173 00:10:44,396 --> 00:10:47,516 Speaker 1: we put out reasoning, that we share the science. And 174 00:10:47,556 --> 00:10:50,276 Speaker 1: I think we're fortunate to work in a city where 175 00:10:50,276 --> 00:10:53,436 Speaker 1: people are responsive to hearing about the science. They don't 176 00:10:53,516 --> 00:10:55,876 Speaker 1: doubt that the virus is real, they don't doubt that 177 00:10:55,996 --> 00:11:00,156 Speaker 1: vaccines work. So addressing really the importance of doing it 178 00:11:00,196 --> 00:11:03,956 Speaker 1: for their own individual health, and then the health orders 179 00:11:03,996 --> 00:11:08,156 Speaker 1: are important in driving up the understanding and the demand 180 00:11:08,596 --> 00:11:12,036 Speaker 1: for vaccine, for people to understand that it's expected, that 181 00:11:12,076 --> 00:11:14,956 Speaker 1: it's required, but this is the most important thing that 182 00:11:14,996 --> 00:11:16,916 Speaker 1: they can do, and that this is going to have 183 00:11:16,956 --> 00:11:19,676 Speaker 1: the most impact over time. So it's using this as 184 00:11:19,676 --> 00:11:22,196 Speaker 1: another opportunity that gets a lot of attention. People are 185 00:11:22,276 --> 00:11:25,636 Speaker 1: very focused on the vaccination mandates. The truth is we 186 00:11:25,676 --> 00:11:28,916 Speaker 1: have the highest rate of full vaccination you know, of 187 00:11:28,996 --> 00:11:33,236 Speaker 1: any city in the US, so the incremental increase in 188 00:11:33,316 --> 00:11:36,396 Speaker 1: this is important. We want every single additional person to 189 00:11:36,436 --> 00:11:39,596 Speaker 1: get vaccinated that we can. We have to marry that 190 00:11:39,596 --> 00:11:42,956 Speaker 1: though with explaining why it's important, and then most importantly, 191 00:11:43,036 --> 00:11:46,916 Speaker 1: we have to have highly accessible routes for vaccination in 192 00:11:46,916 --> 00:11:50,196 Speaker 1: the city as well. The health order load is not perfect, 193 00:11:50,236 --> 00:11:52,396 Speaker 1: as you said, but in my mind, the goal is 194 00:11:52,436 --> 00:11:54,436 Speaker 1: not for it to be perfect. It's really to add 195 00:11:54,516 --> 00:11:57,276 Speaker 1: cumulatively to all the work that we've been doing around 196 00:11:57,316 --> 00:12:01,356 Speaker 1: increasing our resilience and our response to COVID nineteen. I 197 00:12:01,396 --> 00:12:04,516 Speaker 1: think that you know, this requirement for vaccination in public 198 00:12:04,556 --> 00:12:08,396 Speaker 1: spaces is the most recent vaccination requirement, but it's not 199 00:12:08,476 --> 00:12:10,556 Speaker 1: the only one. It's not been. The first one that 200 00:12:10,916 --> 00:12:13,716 Speaker 1: we actually put out as a health order was related 201 00:12:13,756 --> 00:12:17,436 Speaker 1: to higher risk settings, settings in which the people that 202 00:12:17,476 --> 00:12:20,596 Speaker 1: are within those settings are at higher risk for either 203 00:12:20,716 --> 00:12:24,956 Speaker 1: severe illness or death. So that includes our acute care hospitals, 204 00:12:24,956 --> 00:12:28,076 Speaker 1: our nursing homes, our jails, and so that was the 205 00:12:28,156 --> 00:12:31,276 Speaker 1: first place where workers were required to be vaccinated. We 206 00:12:31,356 --> 00:12:35,676 Speaker 1: do have an indoor masth mandate as well, So we've 207 00:12:35,676 --> 00:12:38,396 Speaker 1: had that since the beginning of the month, and so 208 00:12:38,436 --> 00:12:41,156 Speaker 1: we have both. Now we just have this newly implemented 209 00:12:41,396 --> 00:12:45,036 Speaker 1: vaccination requirement in these certain public businesses as we talked about, 210 00:12:45,196 --> 00:12:48,356 Speaker 1: but we do have in all indoor spaces a mask 211 00:12:48,476 --> 00:12:51,676 Speaker 1: requirement as well. I think that the delta variant had 212 00:12:51,836 --> 00:12:57,076 Speaker 1: introduced enough level of uncertainty to not be sure, even 213 00:12:57,076 --> 00:12:59,156 Speaker 1: with our highly vaccinated city, what was it going to 214 00:12:59,236 --> 00:13:01,236 Speaker 1: mean for our hospital system, what was it going to 215 00:13:01,316 --> 00:13:05,036 Speaker 1: mean for people that had already been vaccinated. That we 216 00:13:05,556 --> 00:13:07,836 Speaker 1: determined to do the mass mandate first because it could 217 00:13:07,836 --> 00:13:10,916 Speaker 1: be implemented very quick CLEA and we had done it previously, 218 00:13:11,196 --> 00:13:16,316 Speaker 1: and then work on this vaccination requirement. So going forward, 219 00:13:16,356 --> 00:13:18,076 Speaker 1: what we're going to have to see is keep looking 220 00:13:18,356 --> 00:13:21,516 Speaker 1: at our case numbers. They are coming down slowly, and 221 00:13:21,556 --> 00:13:25,116 Speaker 1: we'll have to see if that continues and decide how 222 00:13:25,116 --> 00:13:27,236 Speaker 1: we move forward. We are going to have to learn 223 00:13:27,316 --> 00:13:31,036 Speaker 1: to live with COVID nineteen in San Francisco and elsewhere, 224 00:13:31,356 --> 00:13:33,716 Speaker 1: but for now we do have both of those measures 225 00:13:33,716 --> 00:13:38,116 Speaker 1: in place. Let's talk about the formulation that you just used, 226 00:13:38,156 --> 00:13:40,516 Speaker 1: which is one that I think is very important that 227 00:13:40,636 --> 00:13:42,356 Speaker 1: we're going to have to learn to live with COVID 228 00:13:42,436 --> 00:13:46,676 Speaker 1: nineteen formulation. And I'd love to hear in more fine 229 00:13:46,716 --> 00:13:50,596 Speaker 1: grain detail what you think that living with is going 230 00:13:51,116 --> 00:13:53,916 Speaker 1: to look like. Let me make the con question concrete 231 00:13:53,916 --> 00:13:56,476 Speaker 1: in the following way. You've got great uptake at eighty 232 00:13:56,476 --> 00:14:00,636 Speaker 1: percent or so of eligible residence getting a vaccine. That's amazing. 233 00:14:01,196 --> 00:14:04,036 Speaker 1: Let's say you got to ninety five, right, which is 234 00:14:04,036 --> 00:14:06,676 Speaker 1: as close to perfect as anyone's going to get. And 235 00:14:06,756 --> 00:14:09,316 Speaker 1: let's say the Delta variant still existed, because it's still 236 00:14:09,356 --> 00:14:12,396 Speaker 1: going to exist, although perhaps it will have burned itself 237 00:14:12,396 --> 00:14:14,516 Speaker 1: out in this latest round, but it or other things 238 00:14:14,556 --> 00:14:16,996 Speaker 1: like it, we'll be back in the future. This doesn't 239 00:14:16,996 --> 00:14:19,436 Speaker 1: seem like it's some outlying evolutionary development. It's a kind 240 00:14:19,476 --> 00:14:22,396 Speaker 1: of to be expected and doubtless will be recurrent in 241 00:14:22,476 --> 00:14:24,676 Speaker 1: various ways. We'll have to learn the names of lots 242 00:14:24,676 --> 00:14:29,596 Speaker 1: of other Greek characters beyond Delta. So in that environment, 243 00:14:30,316 --> 00:14:32,836 Speaker 1: does living with it basically mean that we would move 244 00:14:32,876 --> 00:14:37,236 Speaker 1: towards a world where no mask requirements and we would 245 00:14:37,276 --> 00:14:39,276 Speaker 1: just understand that there was a certain amount of breakthrough 246 00:14:39,316 --> 00:14:41,636 Speaker 1: infection that was going to keep on happening in the 247 00:14:41,756 --> 00:14:45,516 Speaker 1: light of future variants, and we will try to manage 248 00:14:45,516 --> 00:14:49,196 Speaker 1: that and if it requires building more hospital beds to 249 00:14:49,276 --> 00:14:51,996 Speaker 1: be prepared for those potential surges, will do that. Is 250 00:14:52,036 --> 00:14:54,276 Speaker 1: that sort of what you're picturing. Well, I think what 251 00:14:54,436 --> 00:14:58,876 Speaker 1: we'll picture is again continuing to take in any new information. 252 00:14:58,996 --> 00:15:01,196 Speaker 1: You know, and as you pointed out earlier, this virus 253 00:15:01,236 --> 00:15:04,396 Speaker 1: has done nothing if not keep throwing curveballs, and we 254 00:15:04,476 --> 00:15:07,076 Speaker 1: have to adapt to what we might need to do. 255 00:15:07,396 --> 00:15:10,436 Speaker 1: We were not talking about masks early on in the pandemic, 256 00:15:10,476 --> 00:15:13,836 Speaker 1: and that was not in our culture as a country before, 257 00:15:13,876 --> 00:15:16,676 Speaker 1: as it was in some other Asian countries, but it 258 00:15:16,876 --> 00:15:19,796 Speaker 1: is something now. Are we going to have to mask 259 00:15:19,876 --> 00:15:23,116 Speaker 1: completely going forward? I don't think that that's likely, but 260 00:15:23,236 --> 00:15:25,556 Speaker 1: I do think that people may choose during cold and 261 00:15:25,596 --> 00:15:28,676 Speaker 1: flu season in coming years to wear a mask. Hopefully 262 00:15:28,716 --> 00:15:31,036 Speaker 1: people have a sense that if they're sick, they stay home. 263 00:15:31,356 --> 00:15:34,196 Speaker 1: So there are some lessons I think from COVID nineteen 264 00:15:34,196 --> 00:15:37,756 Speaker 1: that I hope do continue pass this current time. And 265 00:15:37,836 --> 00:15:40,956 Speaker 1: I do think that there will be other challenges potentially, 266 00:15:40,996 --> 00:15:44,036 Speaker 1: as you said, other Greek letters maybe coming at us, 267 00:15:44,076 --> 00:15:47,196 Speaker 1: and then we will have to adapt over time. So 268 00:15:47,236 --> 00:15:48,916 Speaker 1: what I'm hopeful is that we will get a high 269 00:15:48,956 --> 00:15:52,756 Speaker 1: level of vaccination that that will continue. We'll understand if 270 00:15:52,756 --> 00:15:56,556 Speaker 1: and when we need to continue having boosters of these vaccinations, 271 00:15:56,556 --> 00:15:58,796 Speaker 1: and then if we need to adjust further, we will 272 00:15:58,796 --> 00:16:02,036 Speaker 1: have to adjust. But I do think that we will 273 00:16:02,076 --> 00:16:04,196 Speaker 1: eventually be able to peel away some of these other 274 00:16:04,316 --> 00:16:08,836 Speaker 1: non pharmaceutical interventions like masking, and we've already peeled distancing 275 00:16:08,876 --> 00:16:12,876 Speaker 1: away and have the vaccine really really hold the bulk 276 00:16:13,036 --> 00:16:17,236 Speaker 1: of the work for keeping population safe. And you know, 277 00:16:17,276 --> 00:16:20,196 Speaker 1: as a health officer, we're working at a population level, 278 00:16:20,396 --> 00:16:22,756 Speaker 1: so we do know unfortunately that there still will be 279 00:16:22,796 --> 00:16:25,796 Speaker 1: people that get infections and get sick. But what we're 280 00:16:25,836 --> 00:16:28,076 Speaker 1: trying to do is really make sure that the bulk 281 00:16:28,116 --> 00:16:31,316 Speaker 1: of the population is protected and that everyone has as 282 00:16:31,396 --> 00:16:33,876 Speaker 1: much information as they might need to make decisions. But 283 00:16:33,996 --> 00:16:36,756 Speaker 1: for right now, as we are working to get all 284 00:16:36,796 --> 00:16:39,596 Speaker 1: of our populations as vaccinated as we possibly can, and 285 00:16:39,636 --> 00:16:42,036 Speaker 1: we don't know where we'll end up with that, these 286 00:16:42,076 --> 00:16:44,036 Speaker 1: are the additional protections that we want to have in 287 00:16:44,076 --> 00:16:47,396 Speaker 1: place using the power of state law, the health officer 288 00:16:47,436 --> 00:16:49,436 Speaker 1: authority to be able to do that. For the moment, 289 00:16:50,556 --> 00:17:03,596 Speaker 1: we'll be right back where does rapid antigen testing, in 290 00:17:03,636 --> 00:17:06,716 Speaker 1: your view, fit into this series of different measures that 291 00:17:06,756 --> 00:17:10,836 Speaker 1: you're engaged in. I got my first wedding invitation post 292 00:17:10,916 --> 00:17:14,596 Speaker 1: COVID today that noted not only that they wanted people 293 00:17:14,636 --> 00:17:18,116 Speaker 1: to prove vaccination to attend the wedding, but also that 294 00:17:18,156 --> 00:17:21,156 Speaker 1: they wanted people to get a rapid antigen test that day, 295 00:17:21,716 --> 00:17:23,876 Speaker 1: not even a PCR test, you know, in the previous 296 00:17:23,916 --> 00:17:26,916 Speaker 1: thirty six hours. And I, you know, thought maybe this 297 00:17:26,956 --> 00:17:29,356 Speaker 1: is the new normal. There's an expense question, of course, 298 00:17:30,036 --> 00:17:33,836 Speaker 1: but when you think about the various components of a 299 00:17:33,956 --> 00:17:39,276 Speaker 1: preventive plan, testing surely is one of them. Prices have 300 00:17:39,356 --> 00:17:41,436 Speaker 1: come down, although not as much as one would have 301 00:17:42,156 --> 00:17:44,836 Speaker 1: hoped thus far. So how does testing fit into the picture? 302 00:17:44,876 --> 00:17:46,636 Speaker 1: I mean, I think, to put another way, how we 303 00:17:46,716 --> 00:17:48,636 Speaker 1: been discussing this at the beginning of the pandemic, before 304 00:17:48,716 --> 00:17:51,396 Speaker 1: vaccines were available. A lot of our conversation would have 305 00:17:51,396 --> 00:17:54,716 Speaker 1: been and we did these conversations on deep background, you know, 306 00:17:54,996 --> 00:17:58,156 Speaker 1: the centrality of testing to a successful regime and the 307 00:17:58,276 --> 00:18:01,156 Speaker 1: mechanisms that can be undertaken to make testing more efficient 308 00:18:01,196 --> 00:18:03,076 Speaker 1: at scale. And yet now it doesn't seem to be 309 00:18:03,156 --> 00:18:06,076 Speaker 1: as central to the at least to the Public Health Conversation. 310 00:18:07,396 --> 00:18:10,356 Speaker 1: I think you're right. You're absolutely right. The testing remains 311 00:18:10,356 --> 00:18:14,076 Speaker 1: really important when you think about schools which are opening 312 00:18:14,116 --> 00:18:17,676 Speaker 1: soon in a matter of days. We still don't have 313 00:18:17,956 --> 00:18:21,796 Speaker 1: authorization for vaccination for under twelve, but for twelve and over. 314 00:18:22,636 --> 00:18:26,556 Speaker 1: Is San Francisco in its public schools requiring vaccination universally? 315 00:18:26,956 --> 00:18:29,596 Speaker 1: You know, in San Francisco our schools opened last week. 316 00:18:29,676 --> 00:18:32,756 Speaker 1: It was very exciting because we had not had all 317 00:18:32,796 --> 00:18:36,276 Speaker 1: of our schools opened during the last year, and so 318 00:18:36,956 --> 00:18:40,276 Speaker 1: we're encouraging them for twelve to seventeen. But they're not mandated, 319 00:18:40,636 --> 00:18:43,836 Speaker 1: and the San Francisco Unified School District has a different 320 00:18:43,916 --> 00:18:47,396 Speaker 1: governing entity. They don't fall under the mayor and the 321 00:18:47,436 --> 00:18:49,876 Speaker 1: rest of the city department, so we work very closely 322 00:18:49,876 --> 00:18:52,036 Speaker 1: with them, but they have a different decision making and 323 00:18:52,596 --> 00:18:56,236 Speaker 1: policy approach and independent of the rest of the rest 324 00:18:56,276 --> 00:18:59,796 Speaker 1: of us and independent of health officer or orders as well. 325 00:18:59,876 --> 00:19:03,836 Speaker 1: They make decisions there, so they are supporting twelve to 326 00:19:03,876 --> 00:19:05,676 Speaker 1: seventeen year olds and the rest of the city. Our 327 00:19:05,716 --> 00:19:08,516 Speaker 1: Health Department is working closely with the Unified School District 328 00:19:08,556 --> 00:19:10,796 Speaker 1: to be able to do that and have there be 329 00:19:10,916 --> 00:19:15,636 Speaker 1: events where entire families can come where we facilitate vaccine, 330 00:19:15,636 --> 00:19:19,156 Speaker 1: and we'll have increasing sites numbers of sites on school 331 00:19:19,196 --> 00:19:22,276 Speaker 1: property to be able to get vaccination, but we're not 332 00:19:22,516 --> 00:19:27,236 Speaker 1: requiring it yet. That was such a beautifully diplomatic answer 333 00:19:27,396 --> 00:19:29,156 Speaker 1: that I almost don't want to draw attention to how 334 00:19:29,156 --> 00:19:32,156 Speaker 1: diplomatic it was. It's a reminder that being public health 335 00:19:32,156 --> 00:19:34,956 Speaker 1: officer of a city is not dissimilar from being, you know, 336 00:19:34,956 --> 00:19:36,796 Speaker 1: an abassador with United Nations or something. You have to 337 00:19:36,836 --> 00:19:39,356 Speaker 1: be careful in what you say. Let me try to 338 00:19:39,396 --> 00:19:41,076 Speaker 1: parse it. I mean, what I heard you say is 339 00:19:41,076 --> 00:19:43,796 Speaker 1: that the schools don't answer to you and they have 340 00:19:43,836 --> 00:19:47,636 Speaker 1: a different policy. Without stating it. The natural implication I 341 00:19:47,716 --> 00:19:49,276 Speaker 1: want to ask you to confirm this or deny this, 342 00:19:49,396 --> 00:19:51,756 Speaker 1: but the natural implication when it might have been that 343 00:19:51,836 --> 00:19:53,916 Speaker 1: you might have reached different decision if they were within 344 00:19:53,996 --> 00:19:56,636 Speaker 1: your decision making authority. Let me use that to ask 345 00:19:56,676 --> 00:20:00,156 Speaker 1: a further question. You know, across the country, this is 346 00:20:00,196 --> 00:20:03,116 Speaker 1: going to be replicated a much greater scale, right, I mean, 347 00:20:03,516 --> 00:20:07,356 Speaker 1: even within a progressive city like San Francisco, it's clear 348 00:20:07,396 --> 00:20:10,836 Speaker 1: that there's some nuanced difference between different agencies at the county, 349 00:20:10,836 --> 00:20:13,836 Speaker 1: at the city level, at the level of the education system, 350 00:20:14,956 --> 00:20:18,356 Speaker 1: and nationally, we've got a huge range of variation all 351 00:20:18,396 --> 00:20:20,916 Speaker 1: the way from where you guys are to you know, 352 00:20:20,916 --> 00:20:23,996 Speaker 1: the governors who prohibited even not just as governors, but 353 00:20:24,036 --> 00:20:27,396 Speaker 1: there were state laws passed signed by governors that prohibited 354 00:20:27,436 --> 00:20:32,996 Speaker 1: mandatory masking. So the other very very grave extreme. When 355 00:20:33,076 --> 00:20:35,476 Speaker 1: you think of this, not just in your role in 356 00:20:35,516 --> 00:20:37,876 Speaker 1: San Francisco, but you know, your role as a national 357 00:20:37,996 --> 00:20:43,476 Speaker 1: leader on questions of public health, are you worried about 358 00:20:43,516 --> 00:20:47,756 Speaker 1: just the range, just the huge disparity of viewpoints that 359 00:20:47,796 --> 00:20:52,316 Speaker 1: we're getting from governmental elected officials on these matters of 360 00:20:52,476 --> 00:20:56,156 Speaker 1: life and death. You know, are these are matters, as 361 00:20:56,156 --> 00:20:59,356 Speaker 1: you said, of life and death, these are public health matters, 362 00:20:59,396 --> 00:21:02,396 Speaker 1: these are scientific matters. And it really has been troubling 363 00:21:02,436 --> 00:21:06,796 Speaker 1: since the beginning of this pandemic how there had initially 364 00:21:06,796 --> 00:21:10,276 Speaker 1: not been a national response. You would think that when 365 00:21:10,316 --> 00:21:13,396 Speaker 1: there was a pandemic that there would be a coordinated 366 00:21:13,436 --> 00:21:15,476 Speaker 1: response at CDC, would be at the forefront, and that 367 00:21:15,556 --> 00:21:20,356 Speaker 1: we as local health department leaders would be responding to 368 00:21:20,396 --> 00:21:23,916 Speaker 1: the same stimuli and not not really trying to do 369 00:21:23,996 --> 00:21:25,916 Speaker 1: our own thing and come up with how we were 370 00:21:25,916 --> 00:21:27,556 Speaker 1: going to get PPE and how are we going to 371 00:21:27,636 --> 00:21:30,436 Speaker 1: do testing, and what was our approach going to be there. 372 00:21:30,756 --> 00:21:33,396 Speaker 1: It's been better more recently, but I think that that 373 00:21:33,596 --> 00:21:36,876 Speaker 1: set the precedent for there being such a diversity of opinion, 374 00:21:37,236 --> 00:21:41,116 Speaker 1: and then this whole way of thinking that masks were 375 00:21:41,596 --> 00:21:44,716 Speaker 1: a sham, that the virus itself was a sham, and 376 00:21:45,276 --> 00:21:50,516 Speaker 1: the splittization of the response of the science of the 377 00:21:50,516 --> 00:21:54,076 Speaker 1: health officials, many of whom my colleagues in California have 378 00:21:54,156 --> 00:21:58,476 Speaker 1: received threats, have really been unduly harassed for just trying 379 00:21:58,476 --> 00:22:01,116 Speaker 1: to do their jobs and save lives. So there is 380 00:22:01,156 --> 00:22:05,196 Speaker 1: a lot there. It is really concerning last question. We 381 00:22:05,276 --> 00:22:07,996 Speaker 1: mentioned the terrific rate of a vaccine uptake that the 382 00:22:08,036 --> 00:22:12,036 Speaker 1: city has. Are there measures that you have of what 383 00:22:12,076 --> 00:22:14,676 Speaker 1: those numbers look like for people who are not just 384 00:22:14,716 --> 00:22:17,636 Speaker 1: poor but are actively homeless in the city, and do 385 00:22:17,716 --> 00:22:21,276 Speaker 1: their numbers look comparable to the general population in terms 386 00:22:21,316 --> 00:22:25,396 Speaker 1: of vaccine uptick. I don't know if we can pinpoint 387 00:22:25,436 --> 00:22:28,876 Speaker 1: the exact numbers. We do know that they are generally 388 00:22:28,916 --> 00:22:31,836 Speaker 1: lower than the general population. But what we've tried to 389 00:22:31,876 --> 00:22:36,556 Speaker 1: do is make mobile vaccination available, allow people to drop 390 00:22:36,636 --> 00:22:38,716 Speaker 1: in and get them at the sites where they get 391 00:22:38,756 --> 00:22:41,916 Speaker 1: their usual services or care and we right now have 392 00:22:42,076 --> 00:22:45,196 Speaker 1: mobile vaccination teams that are going out to work with 393 00:22:45,236 --> 00:22:48,716 Speaker 1: persons experiencing homelessness, so they are a priority, and we 394 00:22:48,756 --> 00:22:50,556 Speaker 1: do recognize that we're going to have to try different 395 00:22:50,596 --> 00:22:54,676 Speaker 1: strategies to increase those rates among those populations in San Francisco. 396 00:22:55,036 --> 00:22:59,756 Speaker 1: And have you gotten broadly speaking yet, the criticism from 397 00:22:59,876 --> 00:23:03,276 Speaker 1: the civil rights community that would be might be worried 398 00:23:03,396 --> 00:23:09,076 Speaker 1: that given differential vaccination rates when measured by socioeconomic state 399 00:23:09,436 --> 00:23:14,276 Speaker 1: or by race, that a public vaccine mandate could look 400 00:23:14,356 --> 00:23:17,316 Speaker 1: like it involves the turning away of a disproportionate number 401 00:23:17,356 --> 00:23:21,236 Speaker 1: of people of color. Because that's obviously, from a straightforwardly 402 00:23:21,276 --> 00:23:27,756 Speaker 1: ethical and legal perspective, that's a grave concern. I agree 403 00:23:27,756 --> 00:23:29,836 Speaker 1: with you that that is a concern from a moral 404 00:23:29,836 --> 00:23:32,796 Speaker 1: and an ethical standpoint, let alone the legal risk. And 405 00:23:32,916 --> 00:23:36,436 Speaker 1: we have again worked with community leaders and ask them 406 00:23:36,836 --> 00:23:40,836 Speaker 1: to help us really reinforce the importance again make the 407 00:23:40,916 --> 00:23:45,036 Speaker 1: vaccine accessible. We wouldn't have done a mandate without a 408 00:23:45,076 --> 00:23:48,996 Speaker 1: feeling confident that we have worked with informed community really 409 00:23:49,036 --> 00:23:51,196 Speaker 1: tried to do that from the beginning. So it's an 410 00:23:51,236 --> 00:23:54,716 Speaker 1: ongoing it's got to be an ongoing communication effort has 411 00:23:54,716 --> 00:23:57,876 Speaker 1: got to be an ongoing support effort with community, and 412 00:23:58,116 --> 00:24:01,996 Speaker 1: relative to other cities, San Francisco's populations of color are 413 00:24:02,116 --> 00:24:05,556 Speaker 1: more highly vaccinated than other areas. So are black African 414 00:24:05,596 --> 00:24:09,956 Speaker 1: American population Sixty five percent vaccinated right now, that's not 415 00:24:10,036 --> 00:24:13,556 Speaker 1: as good as our overall percent of seventy nine percent 416 00:24:13,596 --> 00:24:16,596 Speaker 1: of eligible, but we are working on getting there. That 417 00:24:16,676 --> 00:24:18,276 Speaker 1: number is higher than it used to be, and we're 418 00:24:18,276 --> 00:24:20,476 Speaker 1: going to keep working until it can get higher. Yet 419 00:24:21,156 --> 00:24:24,436 Speaker 1: it's a fascinating problem. I mean, the law professor in 420 00:24:24,516 --> 00:24:28,876 Speaker 1: me immediately pictures the scenario of a disparate impact civil 421 00:24:28,996 --> 00:24:32,836 Speaker 1: rights lawsuit that says, you know that sixty five percent 422 00:24:32,836 --> 00:24:35,116 Speaker 1: of African Americans are vaccinated in the city relative to 423 00:24:35,156 --> 00:24:39,716 Speaker 1: seventy nine percent of the general population. Therefore, you know 424 00:24:39,956 --> 00:24:43,116 Speaker 1: that this band will have a disparate impact on access 425 00:24:43,156 --> 00:24:46,596 Speaker 1: to restaurants, fitness centers, and so forth on the basis 426 00:24:46,676 --> 00:24:50,036 Speaker 1: of race and in other contexts. The progressive position in 427 00:24:50,076 --> 00:24:56,356 Speaker 1: general favors looking at disparate impact independent of discriminatory intent. 428 00:24:56,516 --> 00:24:59,076 Speaker 1: Right the standard progressive position is, we don't care how 429 00:24:59,076 --> 00:25:03,116 Speaker 1: good your intent is. If the law has a disparate impact, 430 00:25:03,196 --> 00:25:06,956 Speaker 1: that's a prima facial reason to treat it as unlawful 431 00:25:07,036 --> 00:25:09,076 Speaker 1: unless a really good justification can be offered, and you're 432 00:25:09,156 --> 00:25:11,756 Speaker 1: case may well be that. And the conservative position is 433 00:25:11,756 --> 00:25:15,236 Speaker 1: typically no, we're only interested in intent when it comes 434 00:25:15,276 --> 00:25:18,196 Speaker 1: to discrimination. We ought not to look at disparate impact. 435 00:25:18,796 --> 00:25:21,076 Speaker 1: Presumably in this case the positions would end up being 436 00:25:21,076 --> 00:25:24,276 Speaker 1: something reversed, right. I mean, it's very clear from everything 437 00:25:24,276 --> 00:25:27,436 Speaker 1: you've said that your overarching goal is public health, that 438 00:25:27,516 --> 00:25:29,676 Speaker 1: you have no interest in any disparate impact. In fact, 439 00:25:29,676 --> 00:25:31,836 Speaker 1: you wish you didn't have a disparate impact on the 440 00:25:31,876 --> 00:25:34,916 Speaker 1: basis of race. But it's a really tricky situation when 441 00:25:34,996 --> 00:25:38,516 Speaker 1: conceptualize in those terms. Yes, I agree with you, and 442 00:25:38,596 --> 00:25:41,556 Speaker 1: I think you. In public health, like in all public policy, 443 00:25:41,436 --> 00:25:44,436 Speaker 1: there's no absolute right or wrong answer. Most of the time, 444 00:25:44,436 --> 00:25:47,196 Speaker 1: there's just trade offs. And so again, what we have 445 00:25:47,276 --> 00:25:49,276 Speaker 1: committed to doing, what I've committed to doing as health 446 00:25:49,316 --> 00:25:53,276 Speaker 1: officer is really to work with populations and try and 447 00:25:53,276 --> 00:25:57,356 Speaker 1: communicate the reasoning, communicate what's coming, to make sure that 448 00:25:57,396 --> 00:25:59,996 Speaker 1: all the stakeholders are aware, and then trying as much 449 00:25:59,996 --> 00:26:02,356 Speaker 1: as we can to say, look, this is also to 450 00:26:02,356 --> 00:26:06,156 Speaker 1: protect the communities of color that are working as weight staff, 451 00:26:06,436 --> 00:26:09,756 Speaker 1: as barbacks as other people who are in them to 452 00:26:09,876 --> 00:26:12,116 Speaker 1: increase the safety at their place of work as well, 453 00:26:12,276 --> 00:26:14,236 Speaker 1: because they have to have that income, they have to 454 00:26:14,316 --> 00:26:16,916 Speaker 1: keep going to work, So there are multiple ways at 455 00:26:16,916 --> 00:26:20,556 Speaker 1: looking at this. As you said complex, Susan, I really 456 00:26:20,556 --> 00:26:23,876 Speaker 1: want to thank you for your time in describing and 457 00:26:24,036 --> 00:26:27,036 Speaker 1: engaging with me about these policies and how you're thinking 458 00:26:27,076 --> 00:26:29,956 Speaker 1: about them. I really value insights into what the new 459 00:26:29,996 --> 00:26:32,116 Speaker 1: normal might come to look like. And I also want 460 00:26:32,116 --> 00:26:34,916 Speaker 1: to thank you for your very intense work over the 461 00:26:34,956 --> 00:26:38,236 Speaker 1: last couple of years in an extraordinarily important and influential position. 462 00:26:38,276 --> 00:26:40,196 Speaker 1: So thank you very much. Thank you very much for 463 00:26:40,276 --> 00:26:43,676 Speaker 1: having me. I've enjoyed talking with you. We'll be right 464 00:26:43,676 --> 00:26:56,756 Speaker 1: back listening to doctor Susan Phillip. It struck me that 465 00:26:56,956 --> 00:26:59,676 Speaker 1: we may be closer than we think to ascertaining what 466 00:26:59,756 --> 00:27:02,196 Speaker 1: a new normal is going to look like, even in 467 00:27:02,236 --> 00:27:06,756 Speaker 1: the aftermath of the delta variant. That is, requirements for 468 00:27:06,956 --> 00:27:10,436 Speaker 1: vaccination at least in place is across the country where 469 00:27:10,516 --> 00:27:14,876 Speaker 1: large numbers of people are vaccinated. Not every place is 470 00:27:14,916 --> 00:27:17,876 Speaker 1: San Francisco, and many places would lack the political will 471 00:27:18,036 --> 00:27:20,676 Speaker 1: or the number of people who are vaccinated for vaccination 472 00:27:20,716 --> 00:27:24,236 Speaker 1: proof requirements to be implemented. Nevertheless, if they work in 473 00:27:24,276 --> 00:27:29,156 Speaker 1: San Francisco, they have the chance of becoming a gold standard. Simultaneously, 474 00:27:29,636 --> 00:27:33,316 Speaker 1: masking requirements which San Francisco, like other big cities, has 475 00:27:33,476 --> 00:27:39,316 Speaker 1: reinstated for unvaccinated people may become an ongoing thing in 476 00:27:39,436 --> 00:27:43,036 Speaker 1: places where vaccination numbers are lower and where there is 477 00:27:43,316 --> 00:27:48,156 Speaker 1: a public health will to protect people. San Francisco represents 478 00:27:48,236 --> 00:27:51,276 Speaker 1: only one possible direction that we might end up going. 479 00:27:51,756 --> 00:27:54,996 Speaker 1: Across the country. There are lots of locations where we 480 00:27:55,076 --> 00:27:59,276 Speaker 1: don't have mandatory vaccination rules, where we don't have mask mandates, 481 00:27:59,476 --> 00:28:02,836 Speaker 1: and indeed, we have plenty of places where state legislatures 482 00:28:02,836 --> 00:28:08,796 Speaker 1: and governors have outlawed mandatory masking. So it emerges that 483 00:28:08,836 --> 00:28:13,236 Speaker 1: our new normal may be highly bipolarized, with very different 484 00:28:13,276 --> 00:28:17,476 Speaker 1: practices in the most progressive places than in more conservative locations. 485 00:28:18,516 --> 00:28:22,396 Speaker 1: As this new reality continues to emerge, we here on 486 00:28:22,516 --> 00:28:26,076 Speaker 1: Deep Background will continue to cover the question, returning to 487 00:28:26,116 --> 00:28:30,076 Speaker 1: COVID as always when there are new developments, new norms, 488 00:28:30,156 --> 00:28:34,436 Speaker 1: and new practices that deserve your attention until the next 489 00:28:34,476 --> 00:28:37,876 Speaker 1: time I speak to you. Breathe, deep, think, deep thoughts, 490 00:28:38,476 --> 00:28:41,356 Speaker 1: and at least if you can provide proof of vaccination, 491 00:28:42,076 --> 00:28:46,116 Speaker 1: go ahead and have a little fun. Deep Background is 492 00:28:46,116 --> 00:28:49,596 Speaker 1: brought to you by Pushkin Industries. Our producer is Mola Board, 493 00:28:49,836 --> 00:28:52,796 Speaker 1: our engineer is Ben Talliday, and our shore runner is 494 00:28:52,796 --> 00:28:57,916 Speaker 1: Sophie Crane mckibbon. Editorial support from noahm Osband. Theme music 495 00:28:57,956 --> 00:29:02,276 Speaker 1: by Luis Gara at Pushkin. Thanks to Mia Lobell, Julia Barton, Lydia, 496 00:29:02,316 --> 00:29:06,516 Speaker 1: Jean Coott, Heather Fain, Carlie Migliori, Maggie Taylor, Eric Sandler, 497 00:29:06,716 --> 00:29:10,036 Speaker 1: and Jacob Weissberg. You can find me on Twitter at 498 00:29:10,036 --> 00:29:13,316 Speaker 1: Noah R. Feldman. I also write a column for Bloomberg Opinion, 499 00:29:13,436 --> 00:29:16,356 Speaker 1: which you can find at Bloomberg dot com slash Feldman. 500 00:29:16,876 --> 00:29:20,316 Speaker 1: To discover Bloomberg's original slate of podcasts, go to Bloomberg 501 00:29:20,356 --> 00:29:23,196 Speaker 1: dot com slash podcasts and if you like what you 502 00:29:23,316 --> 00:29:26,236 Speaker 1: heard today, please write a review or tell a friend. 503 00:29:26,796 --> 00:29:28,556 Speaker 1: This is Deep Background.