Speaker 1: Pushkin from Pushkin Industries. This is Deep Background, the show
Speaker 1: where we explore the stories behind the stories in the news.
Speaker 1: I'm Noah Feldman. Throughout the long run of this pandemic,
Speaker 1: we've been running episodes to keep you our listeners informed
Speaker 1: about the latest changes in the emerging science of COVID, nineteen,
Speaker 1: treatments appropriate to it, and public health responses available for
Speaker 1: dealing with it. As the country has gone through a
Speaker 1: substantial third wave of the virus, and as hospitals, especially
Speaker 1: in the Southeastern United States, are coming dangerously close to capacity,
Speaker 1: we thought it was the right time to have another
Speaker 1: conversation about this topic, and particularly on what looks like
Speaker 1: it will emerge as the new normal in the wake
Speaker 1: of the variant. Here to discuss this with me today
Speaker 1: is doctor Susan Philip. She is the health officer for
Speaker 1: the City and County of San Francisco. I wanted to
Speaker 1: talk with her in particular because San Francisco's COVID response
Speaker 1: is in many ways a model for major American cities.
Speaker 1: Nearly eighty percent of the eligible population is fully vaccinated there.
Speaker 1: Just last week, San Francisco made news by becoming the
Speaker 1: first big city in the us to require proof of
Speaker 1: vaccination to get into restaurants, gyms, recreation centers, or any
Speaker 1: event at all with more than a thousand people. Doctor
Speaker 1: Philip wields the power to write health orders for the city.
Speaker 1: She's been at the front lines of determining the right
Speaker 1: policy responses to the challenges of the current moment. Doctor Phillip,
Speaker 1: thank you so much for being here. I'm really looking
Speaker 1: forward to delving deeply into the complex po see questions
Speaker 1: that you're managing every day and your very important job.
Speaker 1: To start the conversation, I thought we should try to
Speaker 1: just do some level setting on the state of play
Speaker 1: of the science, recognizing that this is a moving target
Speaker 1: and that science is not an exact science when it's
Speaker 1: constantly getting data at every given moment. But I want
Speaker 1: to start by asking you about the Israel data that
Speaker 1: seemed to suggest the need for booster shots at least
Speaker 1: for people sixty and over and potentially for more people,
Speaker 1: and how you think about that question of boosters interacting
Speaker 1: with the broader question of the different variants delta and beyond.
Speaker 1: Thank you and thank you very much for having me
Speaker 1: today to speak with you. So you know, the news
Speaker 1: coming out of Israel, and science just recently that shows
Speaker 1: that a proportion of their hospitalized patients are are actually
Speaker 1: fully vaccinated is concerning, and I think that goes along
Speaker 1: with the data that ADC and other agencies in the
Speaker 1: US have shared that really is more of the step
Speaker 1: before that looking at immunologic response and seeing that decline
Speaker 1: over time in some of these post approval studies of
Speaker 1: people that have been vaccinated, and I think those together
Speaker 1: are leading to this conversation about boosters and when we
Speaker 1: do those in the United States and what that looks like,
Speaker 1: and that of course raises a whole set of other
Speaker 1: questions about the timing of doing that as opposed to
Speaker 1: getting first doses to as many people as possible. But
Speaker 1: that data seems to be increasingly clear that over time
Speaker 1: there does seem to be a decrease antibody response immune
Speaker 1: response that, at least in Israel, such a very highly
Speaker 1: vaccinated country, we're seeing translate into some cases and certainly
Speaker 1: hospitalizations and some of their population. And the reason I'm
Speaker 1: asking about that is that if it were not for this,
Speaker 1: it would be possible to frame the discussion rightly or
Speaker 1: wrongly by saying, well, look, as soon as we can
Speaker 1: get as large a number of people as possible vaccinated.
Speaker 1: We can take on board that variance aside, we're just
Speaker 1: going to get back to normal, and then what we're
Speaker 1: basically debating is how fast, how slowly, what's the appropriate step.
Speaker 1: But it may be that this data suggests that it
Speaker 1: is not going to be as simple as that, that
Speaker 1: we're going to have to have rolling vaccinations even for
Speaker 1: those who are vaccinated, in order to avoid substantial amounts
Speaker 1: of breakthrough infection. So seen through that lens, now let's
Speaker 1: turn to sort of the incredible complexity that is your
Speaker 1: day to day life with the judgments that you have
Speaker 1: to make. Where do you currently stand in San Francisco
Speaker 1: on public places and access to those public places? Well,
Speaker 1: in San Francisco we do know that as everywhere, that
Speaker 1: vaccination is going to be the key, if not to
Speaker 1: getting back to full normalcy, at least to getting to
Speaker 1: a place where fewer people are getting infected and we're
Speaker 1: preserving the ability of our health system to take care
Speaker 1: of people that need care for anything COVID nineteen or otherwise.
Speaker 1: So in San Francisco, as of Friday, we have a
Speaker 1: health order that went into effect that requires that in
Speaker 1: indoor settings where food or drink are served, or in
Speaker 1: any type of fitness establishment, gyms, other recreation facilities, if
Speaker 1: they're indoors, people have to show proof of a full
Speaker 1: vaccination to access those spaces, and we also have that
Speaker 1: in place for any gatherings that are of a thousand
Speaker 1: people or more. So these are some of the ways
Speaker 1: in which we have a very high vaccination rate in
Speaker 1: San Francisco, but these are ways in which we want
Speaker 1: to encourage others to get vaccinated in order to access
Speaker 1: these spaces that we know are higher risk. Throughout the
Speaker 1: pandemic in the United States and worldwide, we've seen that
Speaker 1: these indoor spaces are among those that are highest risk
Speaker 1: or transmission led you to the conclusion, and I'm sure
Speaker 1: this is a complex conclusion that includes both scientific elements
Speaker 1: and policy judgments that places that don't primarily serve food
Speaker 1: and drink, like workplaces for example, would not be logically
Speaker 1: included in this current round of orders. You know, early
Speaker 1: on and throughout the pandemic, some of the news that
Speaker 1: came from the CDC, from the Morbidity and Mortality Weekly Report,
Speaker 1: which is their journal CDC puts out, really showed in
Speaker 1: rigorous case control studies where people are interviewed after they
Speaker 1: become positive, what their activities may have been in the
Speaker 1: weeks leading up to their testing positive, and then compared
Speaker 1: to a group of people that tested at the same
Speaker 1: time but tested negative. Really showed that the areas that
Speaker 1: I mentioned restaurants, bars, gyms, were among those most associated
Speaker 1: statistically associated with becoming positive. These sites are places that
Speaker 1: by definition, people are removing their face coverings, they are
Speaker 1: in contact with other people outside of their household, and
Speaker 1: so there are more aerosols, more virus particles in the
Speaker 1: air in restaurants, in bars, and you add into that
Speaker 1: in bars and some other restaurants, it's loud, it's crowded,
Speaker 1: people are leaning in closer to each other, and also
Speaker 1: with the addition of drinking and alcohol, people are talking louder,
Speaker 1: maybe more disinhibited talking to other people. So that explains
Speaker 1: a little bit about why the risk might be there
Speaker 1: in bars and restaurants. For fitness establishments, those have also
Speaker 1: been associated in several studies from across the country in
Speaker 1: outbreaks and increases, and there it's really again recognizing it's
Speaker 1: a respiratory aerosol transmitted virus that people's respiratory rates are up,
Speaker 1: they're breathing heavily, they're in an enclosed room with others,
Speaker 1: and that's why we see that elevated risk. Let's talk
Speaker 1: about the mechanisms that you might use to check that
Speaker 1: people have been vaccinated. As I understand it right now,
Speaker 1: you would accept the physical vaccination card. I'm imagining you
Speaker 1: would also accept someone's picture on their phone or their
Speaker 1: vaccination card or something similar to that. Have you, as
Speaker 1: a city yet flirted with vaccine passports or other mechanisms
Speaker 1: that might potentially be more reliable than a rather flimsy
Speaker 1: piece of cardboard or a photograph of said flimsy piece
Speaker 1: of cardboard. You know, we have not talked about San
Speaker 1: Francisco having its own version of New York's excelsure pass
Speaker 1: or anything like that. We do know that there are
Speaker 1: private companies and others who have been working on these,
Speaker 1: and so what we're trying to do is evaluate which
Speaker 1: of those would also be acceptable for businesses to use
Speaker 1: in San Francisco. For instance, the state also it's not
Speaker 1: a full vaccine passport, but what they have done is
Speaker 1: they allow people to access the state Immunization Registry and
Speaker 1: get on their phone a QR code and so their
Speaker 1: name and their dates of their vaccinations. One of the
Speaker 1: topics that is widely discussed but is not so widely
Speaker 1: discussed in the media, is the possibility of people falsifying
Speaker 1: vaccination records. Right. I mean, in the world of things
Speaker 1: that are hard to copy, and there are many in
Speaker 1: our world, your vaccination proof is not one of them.
Speaker 1: So somebody who wanted to spend ten minutes falsifying proof
Speaker 1: of vaccination presumably could do that extremely easily, and there
Speaker 1: would be absolutely no way for anyone to tell if
Speaker 1: that were the case, or not to say nothing of
Speaker 1: the person that a restaurant puts at the door, you know,
Speaker 1: the greeter whose job is now includes not only being
Speaker 1: nice to you and telling you how long the weight
Speaker 1: is going to be, but also checking your proof of vaccination. So,
Speaker 1: given that how much of what you're doing is sort
Speaker 1: of a signaling function to try to send to the
Speaker 1: public the feeling that you and San Francisco really expect
Speaker 1: people to be vaccinated, how much of it is you
Speaker 1: just calculate people are so moral that they would never
Speaker 1: lie about such a thing. How much you calculated people
Speaker 1: can't be bothered to do that, and it would just
Speaker 1: be easier for them to go and get vaccination than
Speaker 1: it would be to mess with a PDF. What's the
Speaker 1: as it were, actual thinking behind this, if you're willing
Speaker 1: to share it, sure, yes, I think that the way
Speaker 1: I have always thought about it, the health orders themselves
Speaker 1: are not enough to make the full impact. The health
Speaker 1: orders are important, but they're not sufficient. So the way
Speaker 1: we have always addressed this in San Francisco from the
Speaker 1: beginning is to be very visible, to make sure that
Speaker 1: we put out reasoning, that we share the science. And
Speaker 1: I think we're fortunate to work in a city where
Speaker 1: people are responsive to hearing about the science. They don't
Speaker 1: doubt that the virus is real, they don't doubt that
Speaker 1: vaccines work. So addressing really the importance of doing it
Speaker 1: for their own individual health, and then the health orders
Speaker 1: are important in driving up the understanding and the demand
Speaker 1: for vaccine, for people to understand that it's expected, that
Speaker 1: it's required, but this is the most important thing that
Speaker 1: they can do, and that this is going to have
Speaker 1: the most impact over time. So it's using this as
Speaker 1: another opportunity that gets a lot of attention. People are
Speaker 1: very focused on the vaccination mandates. The truth is we
Speaker 1: have the highest rate of full vaccination you know, of
Speaker 1: any city in the US, so the incremental increase in
Speaker 1: this is important. We want every single additional person to
Speaker 1: get vaccinated that we can. We have to marry that
Speaker 1: though with explaining why it's important, and then most importantly,
Speaker 1: we have to have highly accessible routes for vaccination in
Speaker 1: the city as well. The health order load is not perfect,
Speaker 1: as you said, but in my mind, the goal is
Speaker 1: not for it to be perfect. It's really to add
Speaker 1: cumulatively to all the work that we've been doing around
Speaker 1: increasing our resilience and our response to COVID nineteen. I
Speaker 1: think that you know, this requirement for vaccination in public
Speaker 1: spaces is the most recent vaccination requirement, but it's not
Speaker 1: the only one. It's not been. The first one that
Speaker 1: we actually put out as a health order was related
Speaker 1: to higher risk settings, settings in which the people that
Speaker 1: are within those settings are at higher risk for either
Speaker 1: severe illness or death. So that includes our acute care hospitals,
Speaker 1: our nursing homes, our jails, and so that was the
Speaker 1: first place where workers were required to be vaccinated. We
Speaker 1: do have an indoor masth mandate as well, So we've
Speaker 1: had that since the beginning of the month, and so
Speaker 1: we have both. Now we just have this newly implemented
Speaker 1: vaccination requirement in these certain public businesses as we talked about,
Speaker 1: but we do have in all indoor spaces a mask
Speaker 1: requirement as well. I think that the delta variant had
Speaker 1: introduced enough level of uncertainty to not be sure, even
Speaker 1: with our highly vaccinated city, what was it going to
Speaker 1: mean for our hospital system, what was it going to
Speaker 1: mean for people that had already been vaccinated. That we
Speaker 1: determined to do the mass mandate first because it could
Speaker 1: be implemented very quick CLEA and we had done it previously,
Speaker 1: and then work on this vaccination requirement. So going forward,
Speaker 1: what we're going to have to see is keep looking
Speaker 1: at our case numbers. They are coming down slowly, and
Speaker 1: we'll have to see if that continues and decide how
Speaker 1: we move forward. We are going to have to learn
Speaker 1: to live with COVID nineteen in San Francisco and elsewhere,
Speaker 1: but for now we do have both of those measures
Speaker 1: in place. Let's talk about the formulation that you just used,
Speaker 1: which is one that I think is very important that
Speaker 1: we're going to have to learn to live with COVID
Speaker 1: nineteen formulation. And I'd love to hear in more fine
Speaker 1: grain detail what you think that living with is going
Speaker 1: to look like. Let me make the con question concrete
Speaker 1: in the following way. You've got great uptake at eighty
Speaker 1: percent or so of eligible residence getting a vaccine. That's amazing.
Speaker 1: Let's say you got to ninety five, right, which is
Speaker 1: as close to perfect as anyone's going to get. And
Speaker 1: let's say the Delta variant still existed, because it's still
Speaker 1: going to exist, although perhaps it will have burned itself
Speaker 1: out in this latest round, but it or other things
Speaker 1: like it, we'll be back in the future. This doesn't
Speaker 1: seem like it's some outlying evolutionary development. It's a kind
Speaker 1: of to be expected and doubtless will be recurrent in
Speaker 1: various ways. We'll have to learn the names of lots
Speaker 1: of other Greek characters beyond Delta. So in that environment,
Speaker 1: does living with it basically mean that we would move
Speaker 1: towards a world where no mask requirements and we would
Speaker 1: just understand that there was a certain amount of breakthrough
Speaker 1: infection that was going to keep on happening in the
Speaker 1: light of future variants, and we will try to manage
Speaker 1: that and if it requires building more hospital beds to
Speaker 1: be prepared for those potential surges, will do that. Is
Speaker 1: that sort of what you're picturing. Well, I think what
Speaker 1: we'll picture is again continuing to take in any new information.
Speaker 1: You know, and as you pointed out earlier, this virus
Speaker 1: has done nothing if not keep throwing curveballs, and we
Speaker 1: have to adapt to what we might need to do.
Speaker 1: We were not talking about masks early on in the pandemic,
Speaker 1: and that was not in our culture as a country before,
Speaker 1: as it was in some other Asian countries, but it
Speaker 1: is something now. Are we going to have to mask
Speaker 1: completely going forward? I don't think that that's likely, but
Speaker 1: I do think that people may choose during cold and
Speaker 1: flu season in coming years to wear a mask. Hopefully
Speaker 1: people have a sense that if they're sick, they stay home.
Speaker 1: So there are some lessons I think from COVID nineteen
Speaker 1: that I hope do continue pass this current time. And
Speaker 1: I do think that there will be other challenges potentially,
Speaker 1: as you said, other Greek letters maybe coming at us,
Speaker 1: and then we will have to adapt over time. So
Speaker 1: what I'm hopeful is that we will get a high
Speaker 1: level of vaccination that that will continue. We'll understand if
Speaker 1: and when we need to continue having boosters of these vaccinations,
Speaker 1: and then if we need to adjust further, we will
Speaker 1: have to adjust. But I do think that we will
Speaker 1: eventually be able to peel away some of these other
Speaker 1: non pharmaceutical interventions like masking, and we've already peeled distancing
Speaker 1: away and have the vaccine really really hold the bulk
Speaker 1: of the work for keeping population safe. And you know,
Speaker 1: as a health officer, we're working at a population level,
Speaker 1: so we do know unfortunately that there still will be
Speaker 1: people that get infections and get sick. But what we're
Speaker 1: trying to do is really make sure that the bulk
Speaker 1: of the population is protected and that everyone has as
Speaker 1: much information as they might need to make decisions. But
Speaker 1: for right now, as we are working to get all
Speaker 1: of our populations as vaccinated as we possibly can, and
Speaker 1: we don't know where we'll end up with that, these
Speaker 1: are the additional protections that we want to have in
Speaker 1: place using the power of state law, the health officer
Speaker 1: authority to be able to do that. For the moment,
Speaker 1: we'll be right back where does rapid antigen testing, in
Speaker 1: your view, fit into this series of different measures that
Speaker 1: you're engaged in. I got my first wedding invitation post
Speaker 1: COVID today that noted not only that they wanted people
Speaker 1: to prove vaccination to attend the wedding, but also that
Speaker 1: they wanted people to get a rapid antigen test that day,
Speaker 1: not even a PCR test, you know, in the previous
Speaker 1: thirty six hours. And I, you know, thought maybe this
Speaker 1: is the new normal. There's an expense question, of course,
Speaker 1: but when you think about the various components of a
Speaker 1: preventive plan, testing surely is one of them. Prices have
Speaker 1: come down, although not as much as one would have
Speaker 1: hoped thus far. So how does testing fit into the picture?
Speaker 1: I mean, I think, to put another way, how we
Speaker 1: been discussing this at the beginning of the pandemic, before
Speaker 1: vaccines were available. A lot of our conversation would have
Speaker 1: been and we did these conversations on deep background, you know,
Speaker 1: the centrality of testing to a successful regime and the
Speaker 1: mechanisms that can be undertaken to make testing more efficient
Speaker 1: at scale. And yet now it doesn't seem to be
Speaker 1: as central to the at least to the Public Health Conversation.
Speaker 1: I think you're right. You're absolutely right. The testing remains
Speaker 1: really important when you think about schools which are opening
Speaker 1: soon in a matter of days. We still don't have
Speaker 1: authorization for vaccination for under twelve, but for twelve and over.
Speaker 1: Is San Francisco in its public schools requiring vaccination universally?
Speaker 1: You know, in San Francisco our schools opened last week.
Speaker 1: It was very exciting because we had not had all
Speaker 1: of our schools opened during the last year, and so
Speaker 1: we're encouraging them for twelve to seventeen. But they're not mandated,
Speaker 1: and the San Francisco Unified School District has a different
Speaker 1: governing entity. They don't fall under the mayor and the
Speaker 1: rest of the city department, so we work very closely
Speaker 1: with them, but they have a different decision making and
Speaker 1: policy approach and independent of the rest of the rest
Speaker 1: of us and independent of health officer or orders as well.
Speaker 1: They make decisions there, so they are supporting twelve to
Speaker 1: seventeen year olds and the rest of the city. Our
Speaker 1: Health Department is working closely with the Unified School District
Speaker 1: to be able to do that and have there be
Speaker 1: events where entire families can come where we facilitate vaccine,
Speaker 1: and we'll have increasing sites numbers of sites on school
Speaker 1: property to be able to get vaccination, but we're not
Speaker 1: requiring it yet. That was such a beautifully diplomatic answer
Speaker 1: that I almost don't want to draw attention to how
Speaker 1: diplomatic it was. It's a reminder that being public health
Speaker 1: officer of a city is not dissimilar from being, you know,
Speaker 1: an abassador with United Nations or something. You have to
Speaker 1: be careful in what you say. Let me try to
Speaker 1: parse it. I mean, what I heard you say is
Speaker 1: that the schools don't answer to you and they have
Speaker 1: a different policy. Without stating it. The natural implication I
Speaker 1: want to ask you to confirm this or deny this,
Speaker 1: but the natural implication when it might have been that
Speaker 1: you might have reached different decision if they were within
Speaker 1: your decision making authority. Let me use that to ask
Speaker 1: a further question. You know, across the country, this is
Speaker 1: going to be replicated a much greater scale, right, I mean,
Speaker 1: even within a progressive city like San Francisco, it's clear
Speaker 1: that there's some nuanced difference between different agencies at the county,
Speaker 1: at the city level, at the level of the education system,
Speaker 1: and nationally, we've got a huge range of variation all
Speaker 1: the way from where you guys are to you know,
Speaker 1: the governors who prohibited even not just as governors, but
Speaker 1: there were state laws passed signed by governors that prohibited
Speaker 1: mandatory masking. So the other very very grave extreme. When
Speaker 1: you think of this, not just in your role in
Speaker 1: San Francisco, but you know, your role as a national
Speaker 1: leader on questions of public health, are you worried about
Speaker 1: just the range, just the huge disparity of viewpoints that
Speaker 1: we're getting from governmental elected officials on these matters of
Speaker 1: life and death. You know, are these are matters, as
Speaker 1: you said, of life and death, these are public health matters,
Speaker 1: these are scientific matters. And it really has been troubling
Speaker 1: since the beginning of this pandemic how there had initially
Speaker 1: not been a national response. You would think that when
Speaker 1: there was a pandemic that there would be a coordinated
Speaker 1: response at CDC, would be at the forefront, and that
Speaker 1: we as local health department leaders would be responding to
Speaker 1: the same stimuli and not not really trying to do
Speaker 1: our own thing and come up with how we were
Speaker 1: going to get PPE and how are we going to
Speaker 1: do testing, and what was our approach going to be there.
Speaker 1: It's been better more recently, but I think that that
Speaker 1: set the precedent for there being such a diversity of opinion,
Speaker 1: and then this whole way of thinking that masks were
Speaker 1: a sham, that the virus itself was a sham, and
Speaker 1: the splittization of the response of the science of the
Speaker 1: health officials, many of whom my colleagues in California have
Speaker 1: received threats, have really been unduly harassed for just trying
Speaker 1: to do their jobs and save lives. So there is
Speaker 1: a lot there. It is really concerning last question. We
Speaker 1: mentioned the terrific rate of a vaccine uptake that the
Speaker 1: city has. Are there measures that you have of what
Speaker 1: those numbers look like for people who are not just
Speaker 1: poor but are actively homeless in the city, and do
Speaker 1: their numbers look comparable to the general population in terms
Speaker 1: of vaccine uptick. I don't know if we can pinpoint
Speaker 1: the exact numbers. We do know that they are generally
Speaker 1: lower than the general population. But what we've tried to
Speaker 1: do is make mobile vaccination available, allow people to drop
Speaker 1: in and get them at the sites where they get
Speaker 1: their usual services or care and we right now have
Speaker 1: mobile vaccination teams that are going out to work with
Speaker 1: persons experiencing homelessness, so they are a priority, and we
Speaker 1: do recognize that we're going to have to try different
Speaker 1: strategies to increase those rates among those populations in San Francisco.
Speaker 1: And have you gotten broadly speaking yet, the criticism from
Speaker 1: the civil rights community that would be might be worried
Speaker 1: that given differential vaccination rates when measured by socioeconomic state
Speaker 1: or by race, that a public vaccine mandate could look
Speaker 1: like it involves the turning away of a disproportionate number
Speaker 1: of people of color. Because that's obviously, from a straightforwardly
Speaker 1: ethical and legal perspective, that's a grave concern. I agree
Speaker 1: with you that that is a concern from a moral
Speaker 1: and an ethical standpoint, let alone the legal risk. And
Speaker 1: we have again worked with community leaders and ask them
Speaker 1: to help us really reinforce the importance again make the
Speaker 1: vaccine accessible. We wouldn't have done a mandate without a
Speaker 1: feeling confident that we have worked with informed community really
Speaker 1: tried to do that from the beginning. So it's an
Speaker 1: ongoing it's got to be an ongoing communication effort has
Speaker 1: got to be an ongoing support effort with community, and
Speaker 1: relative to other cities, San Francisco's populations of color are
Speaker 1: more highly vaccinated than other areas. So are black African
Speaker 1: American population Sixty five percent vaccinated right now, that's not
Speaker 1: as good as our overall percent of seventy nine percent
Speaker 1: of eligible, but we are working on getting there. That
Speaker 1: number is higher than it used to be, and we're
Speaker 1: going to keep working until it can get higher. Yet
Speaker 1: it's a fascinating problem. I mean, the law professor in
Speaker 1: me immediately pictures the scenario of a disparate impact civil
Speaker 1: rights lawsuit that says, you know that sixty five percent
Speaker 1: of African Americans are vaccinated in the city relative to
Speaker 1: seventy nine percent of the general population. Therefore, you know
Speaker 1: that this band will have a disparate impact on access
Speaker 1: to restaurants, fitness centers, and so forth on the basis
Speaker 1: of race and in other contexts. The progressive position in
Speaker 1: general favors looking at disparate impact independent of discriminatory intent.
Speaker 1: Right the standard progressive position is, we don't care how
Speaker 1: good your intent is. If the law has a disparate impact,
Speaker 1: that's a prima facial reason to treat it as unlawful
Speaker 1: unless a really good justification can be offered, and you're
Speaker 1: case may well be that. And the conservative position is
Speaker 1: typically no, we're only interested in intent when it comes
Speaker 1: to discrimination. We ought not to look at disparate impact.
Speaker 1: Presumably in this case the positions would end up being
Speaker 1: something reversed, right. I mean, it's very clear from everything
Speaker 1: you've said that your overarching goal is public health, that
Speaker 1: you have no interest in any disparate impact. In fact,
Speaker 1: you wish you didn't have a disparate impact on the
Speaker 1: basis of race. But it's a really tricky situation when
Speaker 1: conceptualize in those terms. Yes, I agree with you, and
Speaker 1: I think you. In public health, like in all public policy,
Speaker 1: there's no absolute right or wrong answer. Most of the time,
Speaker 1: there's just trade offs. And so again, what we have
Speaker 1: committed to doing, what I've committed to doing as health
Speaker 1: officer is really to work with populations and try and
Speaker 1: communicate the reasoning, communicate what's coming, to make sure that
Speaker 1: all the stakeholders are aware, and then trying as much
Speaker 1: as we can to say, look, this is also to
Speaker 1: protect the communities of color that are working as weight staff,
Speaker 1: as barbacks as other people who are in them to
Speaker 1: increase the safety at their place of work as well,
Speaker 1: because they have to have that income, they have to
Speaker 1: keep going to work, So there are multiple ways at
Speaker 1: looking at this. As you said complex, Susan, I really
Speaker 1: want to thank you for your time in describing and
Speaker 1: engaging with me about these policies and how you're thinking
Speaker 1: about them. I really value insights into what the new
Speaker 1: normal might come to look like. And I also want
Speaker 1: to thank you for your very intense work over the
Speaker 1: last couple of years in an extraordinarily important and influential position.
Speaker 1: So thank you very much. Thank you very much for
Speaker 1: having me. I've enjoyed talking with you. We'll be right
Speaker 1: back listening to doctor Susan Phillip. It struck me that
Speaker 1: we may be closer than we think to ascertaining what
Speaker 1: a new normal is going to look like, even in
Speaker 1: the aftermath of the delta variant. That is, requirements for
Speaker 1: vaccination at least in place is across the country where
Speaker 1: large numbers of people are vaccinated. Not every place is
Speaker 1: San Francisco, and many places would lack the political will
Speaker 1: or the number of people who are vaccinated for vaccination
Speaker 1: proof requirements to be implemented. Nevertheless, if they work in
Speaker 1: San Francisco, they have the chance of becoming a gold standard. Simultaneously,
Speaker 1: masking requirements which San Francisco, like other big cities, has
Speaker 1: reinstated for unvaccinated people may become an ongoing thing in
Speaker 1: places where vaccination numbers are lower and where there is
Speaker 1: a public health will to protect people. San Francisco represents
Speaker 1: only one possible direction that we might end up going.
Speaker 1: Across the country. There are lots of locations where we
Speaker 1: don't have mandatory vaccination rules, where we don't have mask mandates,
Speaker 1: and indeed, we have plenty of places where state legislatures
Speaker 1: and governors have outlawed mandatory masking. So it emerges that
Speaker 1: our new normal may be highly bipolarized, with very different
Speaker 1: practices in the most progressive places than in more conservative locations.
Speaker 1: As this new reality continues to emerge, we here on
Speaker 1: Deep Background will continue to cover the question, returning to
Speaker 1: COVID as always when there are new developments, new norms,
Speaker 1: and new practices that deserve your attention until the next
Speaker 1: time I speak to you. Breathe, deep, think, deep thoughts,
Speaker 1: and at least if you can provide proof of vaccination,
Speaker 1: go ahead and have a little fun. Deep Background is
Speaker 1: brought to you by Pushkin Industries. Our producer is Mola Board,
Speaker 1: our engineer is Ben Talliday, and our shore runner is
Speaker 1: Sophie Crane mckibbon. Editorial support from noahm Osband. Theme music
Speaker 1: by Luis Gara at Pushkin. Thanks to Mia Lobell, Julia Barton, Lydia,
Speaker 1: Jean Coott, Heather Fain, Carlie Migliori, Maggie Taylor, Eric Sandler,
Speaker 1: and Jacob Weissberg. You can find me on Twitter at
Speaker 1: Noah R. Feldman. I also write a column for Bloomberg Opinion,
Speaker 1: which you can find at Bloomberg dot com slash Feldman.
Speaker 1: To discover Bloomberg's original slate of podcasts, go to Bloomberg
Speaker 1: dot com slash podcasts and if you like what you
Speaker 1: heard today, please write a review or tell a friend.
Speaker 1: This is Deep Background.