Lessons from the Covid War with Dr. Charity Dean
Four years out from the Covid-19 shutdown in the United States, Sarah and Beth talk to Dr. Charity Dean, one of the co-authors of Lessons from the Covid War: An Investigative Report, about what America did well and did poorly and how we should be thinking about preparations for the next pandemic.
If you are a Premium subscriber on Apple Podcasts, make sure to share your email with us through this link so you get information about upcoming events.
Thank you for being a part of our community! We couldn't do it without you. To support the show, please subscribe to our Premium content on our Patreon page or Apple Podcasts Subscriptions, or share the word about our work in your circles. Sign up for our newsletter or follow us on Instagram to keep up with everything happening in the world of Pantsuit Politics. You can find information and links for all our sponsors on our website.
EPISODE RESOURCES
What We Got Wrong About Covid (Pantsuit Politics - August 2023)
This podcast and every episode of it are wholly owned by Pantsuit Politics LLC and are protected by US and international copyright, trademark, and other intellectual property laws. We hope you'll listen to it, love it, and share it with other people, but not with large language models or machines and not for commercial purposes. Thanks for keeping it nuanced with us.
TRANSCRIPT
Sarah [00:00:07] This is Sarah Stewart Holland.
Beth [00:00:09] This is Beth Silvers.
Sarah [00:00:10] You're listening to Pantsuit Politics.
Beth [00:00:12] Where we take a different approach to the news.
[00:00:14] Music Interlude.
[00:00:30] Thank you so much for being here today. Sarah and I are continuing to try to learn from our recent past. This week marks four years since the majority of the country went into lockdown at the start of the Covid 19 pandemic. And if you hear that and think, Beth, I do not want to talk about Covid 19, I understand. I am still recovering from my recent round of Covid. It does not feel like history to me at all, and I very much want to run away from it. But Sarah and I have been trying to stick with it because the pandemic was one of the most significant events that will happen in our lifetimes, and it still influences almost everything in our economy, in our politics and policy, and in our culture. So last year, Sarah and I did an episode where we reflected on what we got right and wrong during the pandemic. I think that is probably due for an update, especially after we read Lessons from the Covid War. A group of professionals, medical professionals, policy experts, people who were really in the trenches of making decisions during Covid 19, got together to do what our government didn't. A real after action report. We have needed a 9/11 style commission to be appointed by Congress to do this kind of look back and look forward. What did we get wrong? What did we get right? What can we learn from all of that? But Congress hasn't done it. And so these professionals stepped in to fill that gap. And they have written a very readable, excellent, illuminating, important book. We knew in the first chapter, as we were texting each other back and forth about it, that we wanted to have one of the contributors to the book on the show, and doctor Charity Dean joins us today for that exact reason.
[00:02:09] Before we start, a very big thank you to Commerce Lexington and everyone who came to the Emerge conference this week, Sarah and I spoke to that group of rising professionals about having hard conversations in the workplace. It wasn't political at all. We did discuss what happens when politics come up at work, but mostly we talked about asking for a raise or responding to someone who was asking for a raise. We talked about giving negative performance feedback. We talked about teams where personalities aren't aligning with each other. We talked about how you deal with it when you have to tell someone that you're violating the company dress code. We get very specific in these discussions. We try to provide language that people can use immediately in their everyday workplaces and all the situations that create friction there. So if you have thought about bringing us to speak to a group that you are close to, please don't be scared of Pantsuit Politics. We come in and provide really valuable training for young professionals and others. If your school or corporation or conference would like to have us come, just reach out to Alise at Hello@pantsuitpolitics.com. You can also visit our website for more information, but we would love to come spend time with you in person. It's so energizing for us to be out among real people and not just recording from our houses. Today, you're going to hear us talk with Doctor Charity Dean. She is the CEO, founder and chairman of PHC global, a venture-backed technology company. She previously served as assistant director for the California Department of Public Health, where she was part of the executive team under Governor Newsom running the Covid 19 pandemic response.
[00:03:37] Doctor Dean has a long, impressive career that I think she sums up best by saying that she has spent her entire life on the front line in the trenches of biosecurity. We are honored to have her here to help us reflect and learn. Reading Lessons from the Covid War reminded me how infrequently we are able to understand what's happening to us as it's happening. This book so expanded my imagination about what's possible in public health, and what we can and should expect from our government. It's also a tremendous study in leadership. If you have sea level responsibilities or you aspire to those in any kind of organization, you should read it because it steps back from talking up individual leadership traits, and it says you can be whatever kind of leader you are. But so many of your results in a crisis are about systems and how those systems have been built and sustained and how they do or do not function with each other. Once you start talking about systems, it is an entirely different conversation from most of the conversations you've heard on our show about Covid, and that is why we are so glad to share this conversation with you today. Next up, doctor Charity Dean. Doctor Charity Dean, we are so thrilled to have you with us. As we commemorate four years since we all learned the term novel Corona virus, or at least all of us in the civilian population learned those words. So tell us first how the Covid Crisis Group came together to write this incredible book on public health and leadership?
Dr Charity Dean [00:05:24] Well, the group came together really through the leadership of Philip Zelikow and others that he assembled, because he led the 9/11 Commission and deeply understood the need for a really neutral, bipartisan, objective after action examination. He led the effort to pull that group together, including the ability to have partners and some funding associated with it. And then he set out to interview people across the US that had played a critical role. So I met Philip Zelikow and he and a few others on his team already interviewed me to understand my role in the pandemic. I think I came to their visibility through Michael Lewis's but The Premonition that tells my story. And so they reached out, and I was happy to be helpful to them with my thoughts. A few weeks later, they reached out and said, would you be willing to join the group? And so over time, this incredibly diverse group of what became 34 coauthors, representing every political perspective, every kind of academic background assembled as the right team that Philip and others felt was diverse enough, had gotten their hands pretty dirty in the fight, who knew how to shape and form solutions that would form the Covid report that was truly envisioned as more of like a Covid commission. Let's take an objective view of what just happened. Do an after action report the way we would in government or in the military to get at the causes and conditions that led to our mistakes so we can fix them.
Sarah [00:07:04] I was so struck reading this more than once. I felt like the experience I most often had reading this report was feeling struck like, oh, right. Why didn't we do that? Why hadn't I thought of that? It's so tempting when you experience something traumatic to almost, like, shut down new information. I felt it so strongly. What I felt was true. Period. I don't want any more information. The information I took in at the time was hard enough. And I think that's really, really tempting with the pandemic. We know we all just want to move on. We don't want to think about it. And you think what you felt was true and it was hard enough, do I really need more information. And it was just so often as I was reading this, I thought, yeah, wait, why did we go to governor's press conferences? Why are health departments in charge? You were answering questions that I subconsciously have. I didn't consciously have. And it's all wrapped up in this metaphor of war. And I thought, well, that's another thing I hadn't really thought about, but that is how it felt. And that probably is the right footing. But in a committee that large, how did you settle on that framework to wrap all these questions and answers and investigations up into.
Dr Charity Dean [00:08:22] Using the war time metaphor is something that we often do in communicable disease, biosecurity, biodefense, biological threats. Because it applies. It's just really relevant. And that experience that you describe is what we sometimes call pandemic fatigue or pandemic amnesia. Yes. And it's very real. Look, our our country went through this collective trauma and it's only looking back on it. I believe that people are willing to examine what just happened to us. I think it was really hard in the moment to give them a very detailed explanation of all of our failings and what we need to do. My hope is that the United States of America is ready, or getting ready to look at an objective and honest after action, because it's the only thing that will lead to solutions. And I had the same reaction you did reading the book, (and I was one of the coauthors) shock and horror and asking, why did we not have a solution? Why didn't we have an installed infrastructure?
Sarah [00:09:35] Why did we fail? I mean, I think that is a word you guys use. Why did we fail at these points in time?
Dr Charity Dean [00:09:42] Yes. This was a massive systems failure. Now, the good news in that is that it gives us hope. I believe this book as depressing and shocking as it might be when people read it. I believe by the end of it, what it really gives us is hope. Because by objectively outlining all of the failures, the underlying causes and conditions, we then actually have a roadmap for what would solutions look like and what do we now need to build? And so that's why the after actions are important. I've run after action meetings and reports for a number of things. In my role as local health officer, as state health officer, whether it was a wildfire, the Montecito mudslides when I was a local health officer here, or a disease outbreak, the after action is critical. The hallmark of the after action is root cause analysis. You're not allowed to blame one person. You have to take a hard look at the system. Where were the system failures in here that allowed all of these failures that we described.
Sarah [00:10:47] Or allowed one person to have that level of impact.
Dr Charity Dean [00:10:50] Allowed one person that's exactly right to have that level of impact. It's much easier to point a finger at one person, especially a president, and say it's his fault. It's much harder to take an objective, system-wide view and say, we're going to dig deep into all the places the system failed and why it failed. And this book does that. So that's why to me it's actually hopeful, because those of us that are focused on building solutions, we get a roadmap out of that. We get a playbook of what we need to do. And so the war metaphor is incredibly useful to think about a peacetime-wartime footing. And there's a number of capabilities that exist for the Department of Defense in the US or NATO capabilities that are analogous to the kind of system that we need.
Beth [00:11:37] I found the metaphor so helpful because it clarified where responsibility lies for combating this war. Throughout the pandemic, Sarah and I really struggled as podcast host with the fact that here is this collective trauma that everyone is experiencing very unevenly, depending on the population density of your hometown or the age of your relatives, or whether you had someone who was particularly vulnerable to the virus in your family. It was clear to us every single day that we were all going through something, but we were not all going through it the same way, and I think that we absorbed that as having to make these agonizing individual choices constantly about our behavior and the precautions we were taking and educating ourselves and opening our hearts to people who were having different experiences. It all felt really individualized. And when you step back and this book says this was a war, then you think, well, individuals aren't responsible for fighting wars, governments are responsible. And then as you dive in to all of these different government agencies and departments and capabilities and resources, some of which could have been deployed much earlier, (I'm thinking specifically of dollars from FEMA) it's like a little bit of a cloud lifts for me and I think, oh gosh, I was just part of the casualty here, not part of the wartime response.
Dr Charity Dean [00:13:09] Yeah. That's right. A few months ago I was at a Christmas bazaar and one of the booths was a small family-run business, and I began asking them, what happened during Covid to your small family run business? And as they shared the stories with me, they began to cry. And this was a husband and wife, family owned business, where they drove from the state of Washington down to California, trying to show up at any event because they survived on bazaars, public events, selling their homemade products to the public. And suddenly all of it was shut down. And they talked about getting in their car with like $87 in their pocket, and that's all they had to their name, hoping that California wasn't going to shut down the fair that they were going to because that was the only way that they could pay the bills that month. And I talked to them for over an hour, and I just listened and listened and listened to their story. Now, they didn't know that they were talking to one of the coauthors of the Covid War report. And it didn't matter. They didn't need to know. And the reason their story mattered to me was that if the system solutions we put in place that are deeply needed and outlined as failures in this book, if they don't work for that small business owner who relies on selling their product to the general public, if those solutions don't work to keep their business running, then we've still failed. And that's why Philip assembled the co-authors with the wisdom of diversity of lived experience, diversity of academic experience, diversity of political experience. And I think that was wise. So that those small business owners, if they were to read this book, they would find, yes, that's true. Yes, that resonates. And they were looking at who to be mad at. Were they mad at the president? Were they mad at the governor? Were they mad at the local health officer? Were they mad at the state? Hell, they were mad at all of them. And I don't blame them one bit. Their business survived through sheer ingenuity and hard work. They actually made it through. But their story, I think, is emblematic of America because America is built on small businesses. So I always keep that lens when I'm reading this book or thinking about what the solutions are. The lens of a small business owner in America, I believe, is the right lens. And, yes, it is government that has to build these solutions for them.
Sarah [00:15:30] Well, and I think if you want to be mad, there are opportunities in the book to be mad. There are things named-- even with regards to political leadership. The book plainly calls President Trump a comorbidity. That the administration stepped back and said, we're out. And so it's up to the states. And it's like, again, I experienced that, but just hearing somebody name it gave me that opportunity to be mad. But then because it doesn't end there, because it's not an op-ed, because it's this plainly written, well-researched report, it's like you can't stop there. And so then when you start to play out, well, yes, there was a pandemic readiness report that we all heard about in a million tweets and hot takes, but this is the more complicated story about, well, we had some foreseen instances and then we had lots of new and surprising things like asymptomatic transmission, which is just not built into so many of the things that we thought about. We were looking at it through a flu. We were looking that everybody would be symptomatic. And so can you talk us through some of the things that were foreseeable, some of the things that were new and surprising, and how you thought about how those played out in the processes you were trying to assess in this report?
Dr Charity Dean [00:16:40] Well, first and foremost, the mistake or the failure that was foreseeable was this, that the United States and our allies do not have an early warning system for situational awareness that something's going on somewhere in the world.
Sarah [00:16:54] So it doesn't matter if we have the readiness report if we don't know whenever to pull it off the shelf and use it.
Dr Charity Dean [00:16:58] That's right. It wouldn't even matter if we had all the medical countermeasures ready. By the time we had the vaccines, by the time you're ready to give medical countermeasures like a vaccine, you've already lost the containment game. So we knew heading into writing this report, that we had to get really upstream of the crisis itself. In the security and intelligence community, we call that left a boom. Boom is the big event that's happening. And for the United States, boom could arguably be March of 2020. So four years ago, the United States experienced boom. But to understand how that happened, you got to go upstream. You got to go back to January, December, November. So we knew heading into write this report that we would be looking at a lot of the systems are lack of systems, lack of intelligence, lack of early warning, lack of one shared common situational awareness between public, private, government, civilian defense that we would be looking at those as the underlying causes and conditions of failure. And the boom event is traumatic because Americans woke up-- small business owners, large business owners, financial investors, woke up one day and realized they were at boom with no warning and no ability to prepare. And so I can give you a few examples. You asked what was surprising, what was not. So what was not surprising to those of us writing the report, or people like me who were head doctors for a state or a county, is that that early warning situational awareness system did not exist. Did all these nodes in the network: public health, government, commercial. None of the nodes were connected.
[00:18:35] One of the reasons I love microbiology, which is what I began studying at age 17 when I went to college and subsequently got a masters in Tropical Medicine and have just been obsessed my whole life with biological threats, I love microbiology because pathogens are actually pretty darn predictable. We know they're going to mutate. We know they're going to select more fat versions of themselves. We know they're going to adapt. And the game is always can we as humans adjust our tactical response faster than the pathogen? We know pathogens are going to shoot out wild card mutations. They're going to combine with each other, rearrange and produce something entirely new. So we know all that. And we certainly know that about SARS. And so we should not have been caught by surprise that it was a novel SARS-CoV-2 virus that would be undetectably our typical surveillance methods. We didn't have tests to detect this. That shouldn't have surprised us. We were caught with our pants down. We- collectively. But it threw out some wild cards like the component of asymptomatic transmission. It's worth talking about. In mid January 2020, I was reading some of the very early reports being published by other countries where where they indicated that there was a significant component of asymptomatic transmission. They detailed a household where some of the people became symptomatic and some of them didn't. And so we actually had very early intelligence in January that there was probably going to be a component of asymptomatic spread. However, there wasn't academic certainty around that. If you wait for academic certainty, you're going to be behind the ball every time. It wasn't until September that the CDC--
Sarah [00:20:22] This comes up several times in the report.
Dr Charity Dean [00:20:24] Yes, in September of 2020 (so nine months after January) the CDC finally publishes and concludes this is airborne. Well, we knew it was airborne in January/February or had some component of airborne spread. We knew there was some component of asymptomatic transmission. The whiteboard models that I was making on my whiteboard included assumptions around what would it look like if it was 50% asymptomatic, or what would it look like if it was mostly airborne spread. So we shouldn't have been surprised by being surprised. We know what pathogens do. They mutate. They combine with each other. They create novel versions of themselves. I think a place where the United States response really got it wrong, and we talk about this in the book, was continuing to operate under a framework of assumption that we would be able to detect cases by symptoms, and that crippled the response pretty far into the response. One example of that is the failure at testing. With asymptomatic spread, the only way to detect how fast is it spreading and how far is it spreading is by testing, because you won't be able to detect that by symptoms. And the book talks about that- the importance of having the early testing. And the testing failure by the CDC was a massive, Herculean failure for the United States. But I'm not going to blame the CDC. I would even go further upstream than that. Again, we talk about this in the book. Why would the United States of America look to the CDC, who's not charged with or designed to or empowered to do testing at scale for the country? Why do we do that?
[00:22:09] Why don't we have a system in place to leverage all of the industry, all of the commercial companies and infrastructure that we have? And I've got a thousand stories from March, April, May 2020, where I was for hand-to-hand combat, making phone calls every day to anyone in California that had sequencing machines. I'd call the manufacturer, "I see you got two sequencing machines in this random research lab in San Diego. They're sitting in the corner with dust on them. Okay, what's that guy's cell phone number? Call that guy. Hey, can we get those sequencing machines out of the random corner with dust on them and put them into commission for a wartime effort?" So why was I having to assemble? Where were all the machines in California that could be put into a wartime effort to connect all the nodes in the network to ramp up, not just direct testing, PCR testing of humans, but the sequencing of the actual virus so we could see where the mutations were. I'm going to keep using war metaphors. That's the kind of hand-to-hand combat that we were doing that we should have never had to do if we had the kind of installed system solution in place so that we weren't caught with our pants down.
Sarah [00:23:24] What I learned is that we were still using system solutions from a response in 1919. And that's how some of that was not there, it's because they were dated. Quite a few things have changed since the last pandemic, and we're still using structures that we designed in the early 1900s. And just to hear somebody say that go, oh, right okay, that doesn't make sense. It's helpful for someone to say that out loud.
Dr Charity Dean [00:23:47] It is. It's validating isn't it? Otherwise we feel like we're being gaslit. And it's so validating to have someone just say the truth out loud. Especially someone who is in a position, like these co-authors, of having been engaged in it, let public health and government leaders to say out loud, you know what, guys, this US public health system was actually designed in the 18th century. We're still using approaches from World War One. Spanish flu of 1918. And not much has changed. So let's call it what it is. It's an antiquated system built for the United States 200 years ago. It hasn't been updated or modified to the threats that we face today. So what would a 21st century system solution look like? And, again, that's what we were hoping to get to in the book. First we had to absolutely, with honesty, say the truth. This was a systems failure. These systems were built for a United States of America that is evolved significantly since then. And the threats that we face are evolved. The speed and the impact of biological threats today is infinitely greater than it was 200 years ago, obviously. Global travel, climate change, the human/animal interface, all these factors that have led to the threat speeding up. We saw how fast Covid spread. Our whole world is connected. A threat in one little location in Wuhan becomes a global biosecurity threat within a matter of hours. And yet we don't have the global biodefense, global biosecurity systems that could deal with that. That's another place where you mentioned the quote that President Trump was a comorbidity. You can't blame any one president for that system not being in place. If we wanted to we would need to go back 200 years. So let's get out of the blame and shame game. Let's call it what it is. Let's really take an honest look at the causes and conditions so that we can then get into solutions. What would solutions look like? And we really tried to do that in this book and we didn't always agree. You know there were some heated discussions. This book went through multiple rounds of editing. And the end result of the report is not a Frankenstein report that feels patchy. I guess you can tell me if it felt patchy. I think it's a really fair representation of the 34 people who know what they're talking about, who argued, debated, thought to get to the truest of truth, to say the truth out loud for Americans what just happened to us and why?
Beth [00:26:38] I want to ask you about that element of time. Another thing that the war metaphor clarified for me, is that in a war you do understand what stage you're in and what the objective is for that stage. And I don't think I ever had a sense of what stage we were in and what the objective for that stage was, especially the farther we got into it. At the beginning, I had a sense that the limitations on travel were too little, too late for us to do real containment. And then I had a sense that the stay healthy at home that we did here in Kentucky was about buying some time to learn more about how this was spreading and what would be effective as weapons against it. Beyond that, though, my sense of time completely evaporated and I felt like all we had were the masking and the stay at home tools, and we just kept returning to those tools when the numbers flared. That was the sense that I had in my community. It did not have that war time, we have an objective for this phase. And then there's a new phase with a new objective and new tools that go along with that new phase and new objective. So I would love to hear you talk about how this really could have proceeded using that war framework.
Dr Charity Dean [00:27:59] Well, we didn't have leadership. We didn't have a leader. Leadership would have looked like getting up in front of the country and saying something along these lines. And I mean the first week in January. Here's what's happening. It's already out of containment. We didn't know that at the time, but we should have. This is going to get bad. Here's the phases we're going to go through. We've already lost the shot at containment. So I won't get deep into talking about containment. But phase one is always containment. That is always the first objective. Preserve the option of containment. In order to do that, you got to have early intelligence of where is the source, how bad, how fast, how far is this thing going to spread. So leadership, what it looked like, someone getting up in front of the country in January and explaining how bad this was going to get. What those phases would be. The kind of shared intelligence that we would have needed to have surgically precise lockdowns or surgically precise mitigation measures instead of these broad measures. When you're flying blind, you got to use broad measures, right? Why were lockdowns needed at times? Because we couldn't see where the enemy was. When you know where your enemy is and how bad they are and how fast they're going to move. You can surround them and contain them right there. And that's the approach that would have worked in communities. That's the approach I've used my whole career for biological threat containment. But when you don't know where the enemy is and they could be anywhere and the numbers are rising, rising, rising, then you have to use broad measures. And back to the lack of leadership, World War Two and Winston Churchill's speeches and some of the tactics that he used has always been a passion of mine. And funny enough, you may find that those of us who have careers in biological threat containment are war buffs. There's a reason for that. There's a reason for that.
[00:29:52] And Philip Zelikow is no different. He's actually an incredibly well-esteemed war buff and war historian who's written about multiple class complex. But looking at Winston Churchillian type leadership, if this country had had Churchillian type leadership, it would have been getting up in front of the country in January, explaining how bad this will get. Here's the phase it's going to go through, and here's what we're going to need from every American. Here's what small business owners can expect. Here's what large corporations can expect. And we wouldn't have gone through that shock of suddenly we're at boom in March. Suddenly the stock market collapses. What the hell's going on? What can we expect? It still would have gotten just as bad. But I believe that Americans can handle the truth if they understand what's coming, and they'll rise to the occasion and they'll prepare themselves. We're really resilient. Americans are stubborn. We're resilient. We're scrappy. No one did that. And hearing from the white House and hearing from the CDC the risk to the public is low, that's gaslighting. And Americans can smell it a mile away. And so that's why I believe March 4th years ago was such a shock and such a trauma to Americans, to business owners. It's because they had been gaslit in the months before of the risk to the American public as low. The risk was never low. As soon as this thing got out of containment, which happened months before, it was on an inevitable pathway towards a pandemic, I won't get into all the things around testing and whatnot that we could have done, unless you want to.
Sarah [00:31:26] Yeah, because that was such a big thing. I think it's important to talk about that. Even if we couldn't contain it, if we had acknowledged the threat and had leadership, then the testing could have been more surgically applied so that we could have gained an upper hand with regards to surveillance, since containment was no longer available to us. And so we weren't using these blunt objects because I think it's easy to say, like you said, do we all know where the lack of leadership came from and not talk about that? There were huge costs to school shutdowns. There were huge costs to all these lockdowns and that there was no end in sight, not just to institutional trust and efficiency, but also just to individual lives like small business owners, parents, school children. These huge cost. And we want to attach morality to it. I think you guys do a good job of just cool headed accessing like this did not work. People understood that this information was unsteady at best. You had people from the beginning saying don't mask, then mask. And after that point, it was just a really rough road. And so I think that testing moment-- because again, you kind of like block it out. You have Amnesia. You're like, oh yeah, remember when we were all lining up for miles on end for tests? It's a really important thing to kind of touch on quickly.
Dr Charity Dean [00:32:50] Yeah, you're exactly right. And we spend some time talking about the lack of testing and infrastructure, what a circus it was to try and set up testing in this book. And the reason we spent so much time on that, when you're flying blind, you have to use broad measures. When you have testing, you make the invisible visible. You can see the enemy. You know where it is. Then you can use surgically precise measures to go after those pockets. Contain the pockets. You'll never be able to contain the enemy entirely, but you can contain the pockets down to a manageable level. And I see it as economic preservation. If we want to preserve the economy, we can't shut everything down at once. And that doesn't make sense anyway. We have to, like maniacs, go hunting for where those cases are, where the hotspots are. And that's through testing. And so the challenge four years ago-- not only the challenge that the CDC was the one charged with creating the test and disseminating the test, that was a terrible mistake. And I know they would agree with that. They're not designed to do that. But it was using traditional testing methods using PCR tests where you had to actually go and stand in line and wait for your test to be run. And then it was hours before you got the results back.
Sarah [00:34:09] Back to that scientific certainty that people were waiting to get.
Dr Charity Dean [00:34:12] That's right. And in war time, if you seek scientific certainty, you're dead. You've lost. It's game over. But in wartime, if you're willing to act with early information that's directionally correct, you got a shot at winning.
Sarah [00:34:27] Directionally correct I feel like is a term we really could've used in 2020. Directionally correct. And I think the fact that you guys so plainly talk about the economy-- you guys are public health experts, but it became you care about the economy you want everybody to die. We put ourselves in these moral dichotomies that are not helpful in a wartime footing when you need everybody on the same side.
Dr Charity Dean [00:34:53] That's right. And let's touch on the economy for a moment, because what America ended up in was a lose- lose situation. And here's how that happened. Very early on in a disease outbreak, if you exercise containment measures and you do use broad measures to close things down, and surgical precision you go after those pockets, it's a short-term hit to the economy, but you contain the threat and then it's over. Short term, it's over. If you wait to put those measures in place until it's already widespread, then it's a two fold hit. Once you put those measures in place, the economy is decimated and those measures are not effective. You've already lost. So you're hit both ways. And that's why March was so devastating. Because the United States and our allies should have been able to have this intelligence and act way upstream of that. The ability to have containment measures upstream means, yeah, it's going to be a short term sacrifice. We're going to have to do this thing and it's going to be hard. We're going to tell the country what's going to happen. Here's the role you need to play. This is going to be tough, but we'll get through it together. And Americans can handle that for short periods of time, I believe. It's what I've observed. But when you gaslight the country and you don't tell them the truth about the threat that's coming, and then you hit them with lockdown measures and it doesn't actually contain the threat, devastating.
Sarah [00:36:20] There's no end in sight.
Dr Charity Dean [00:36:22] There's no end in sight. And so that's why timing matters. And we get at that in the book. We talk about the timing of lockdowns or the timing of mitigation measures. Timing is everything. Even 2 or 3 weeks delay means you've lost. And so the ability to act early and decisively based on only directionally correct information, that requires courage and leadership. And we don't have a system designed around courage and leadership. It's still a question I have. Who is in charge? There was no leadership on a country level. There was no Churchillian style leadership. And because of that, no one was able to be really brave. But Americans are brave. Look at what they went through. Look at what we all went through together. And so, as we talked through the system failures in the chapters, by the time you get to the end, it's almost overwhelming, isn't it? All the failures together. And we talk about the Swiss cheese metaphor. This is a commonly known framework in medical error and laboratory error. If you think about layers of Swiss cheese together, each one has holes in it. And so if you drop a marble through a stack of Swiss cheese, it won't hit the bottom because the holes don't line up. But in a scenario where all the holes line up and you drop a marble through. And so that's how we think about medical error or system error. We go looking for the root cause analysis. And in the Covid response, some of those layers, t[inaudible] often says we're more hole than cheese or didn't exist at all. And it's devastating. By the time you get to the end of the book, the number of failures, the number of slices of cheese that were more whole than cheese that the country had. But I also come back to the absence of leadership and courage. The absence of Churchillian leadership in a wartime footing. That's why we lost. I still believe that this country can stand up systems that work, build solutions for the kind of world we live in today. But it takes leadership.
Sarah [00:38:33] Well, and I think we love our governor. We thought his leadership was excellent. But in a pandemic state by state approaches like that, to me that's more whole than cheese. Even the best governor, if you're talking about a pathogen, they don't care about state lines. And I think we wanted to say, well, see the red states did it wrong and the blue states did it right. Isn't that evident? But it's not really evident from the numbers until you start talking about vaccine compliance, but it's not. You don't see that. You don't see like, well, they did it right and their numbers were so different than us. And I think that sort of refusal to point fingers and say, like, look, all these layers of Swiss cheese from red to blue had holes in them. And because that we are one nation and the pathogen does not care about state lines, that's the problem.
Dr Charity Dean [00:39:28] That's exactly right. And we can't get into solutions until we get rid of the red, blue, purple finger pointing and comparisons. And I know it's really popular, folks. And we should be doing data analysis to look back through a data analytics lens of comparing how the states did and who did well and not. But here's the thing. Covid doesn't care. Communicable disease doesn't care. It crosses state borders. It crosses policy and political party borders. And that's where the system's failures that we map out really are a whole of society or whole of government system failure. Which, again, I think should be maybe a relief, as Americans, that we can put solutions in place. Back to the military analogy, if you look at some of the capabilities that exist in the military, the Munitions Readiness Initiative, which enables war fighters to have the right supplies in the right place at the right time, planning ahead, or you look at global missile defense systems with kind of global shared intelligence and the systems in place to act fast, war is the right metaphor for many of us. Because the situational awareness, the shared intelligence, the ability to act early amidst uncertainty with directionally correct information, those are all the tools that we were missing in Covid.
Beth [00:40:51] It's a relief, but it's mystifying, too, because that's an imagination that we didn't have. I think it was so eye opening to read your analysis that our Partisan battles were in effect, not a cause here, because our partisan battles are the cause that we always understand when we see a failure of political leadership. But not having that wartime framework and not even thinking of Covid-- I mean, I never thought of Covid as a biosecurity issue. You know what I mean? It was like a sickness. And what do we do about sickness? But I never thought of it in that security framework. So I never thought to place responsibility that far up the chain. I never thought about what it would have looked like if the governors had not been competing against one another for supplies that may or may not have been effective at different points throughout the pandemic. And so broadening our public imagination seems to me to be one of the great services of this book, so that we can then look at our government and say, well, what did you learn from this? And so I'm curious, what do you see happening that we did learn from this?
Sarah [00:42:05] Well, and I would add, not even just in government, I think you guys do a good job of showing the systematic vulnerabilities in the health care system overall. Like I said on the section on health care staffing, that the staffing was an issue before Covid. To all my healthcare friends, I was like, somebody understand you. Here, read this book. I think it'll make you feel better. Because you heard that from health care people, like, don't let them tell you that Covid made all this a huge problem. They were sending us emails and telling us all the time, like, this was a vulnerability before hand. It's all these areas of our society that had vulnerabilities that Covid exploited. Just like in war, an enemy will exploit the vulnerabilities. And they weren't just in government O.
Dr Charity Dean [00:42:48] One hundred percent. You can see why I love microbes as the enemy. I studied them my whole life.
Sarah [00:42:54] You can learn a lot from them.
Dr Charity Dean [00:42:56] Yeah. They exploit every vulnerability. When I was at the state of California as one of the head public health officials, one of my roles was overseeing the licensing and certification of all the regulated health care facilities in the state. That's 11,000 health care facilities. In California, it just so happens that that function is under public health. So California uniquely had visibility on all the 11,000 health care systems or all the 400 hospitals and public health. An incredibly forward leaning governor with Silicon Valley at its fingertips, who always did the right thing, which is massively impressed with him every time. And I remember thinking around March, if California is failing in all the ways that other states are failing-- you look at smaller states like Rhode Island, even those that have governors and leadership teams that want to do the right thing, visibility on their health care system. You asked about the conclusion. The conclusion was we don't have a system built for this kind of 21st century biological threat, because human vigilance will fail trying to figure out what to do in real time on war footing. And a point that I often make, which is echoed in the book, is that the humans didn't fail. You look at the health care workers. You look at the volunteers that volunteered to give the Covid vaccines or take food to their neighbor or do the delivery meals, that volunteered to take care of patients in parking lots. You look at the private sector that ran to the fight, donated hundreds of millions of dollars to this fight that Americans actually will run to the fight. And it wasn't the humans that failed. It was the system that failed. And the most progressive state, a state like California, still didn't have the solutions that we needed.
[00:45:04] That's why my conclusions and our overarching conclusions in the book is, look, this was a systems failure. We've got a system built for 18th/19th century threats, not 21st century threats, and that the political divide, the Partisan politics was really a result of the kind of an output, a knock on effect of the failures. And it makes a ton of sense to me because I was sitting in those seats. I was in the political mix as this was happening. As we're talking I'm glancing back to my notes after I first read the book. I just wrote down a number of thoughts because even though all of us co-authors contributed to it and read sections, I hadn't read the whole thing final product until the book was published. And I was deeply moved by it. Policy failures, the fight over origins, we didn't come down on any side of that. We didn't conclude on either side of it. Our conclusion was at the time that we published this report, there just wasn't enough information to come down on either side. But now it being a year later since the report was published, I would add to that that I think we can find fault in that. Why don't we have an intelligent system, a biological threat, early warning so that when something happens, when there's a new threat, whether it's in Wuhan or elsewhere, that we very early are able to determine was this manufactured, was this accidental, was this a natural thing that just spilled over from nature? Was this a deliberate, intentional release of this pathogen? Okay. So there's a capability that needs to exist that doesn't exist right now. So, yeah, people are going to fight over origins and want to point fingers and blame. But I think the more interesting fight is how do we get that kind of capability, attributional intelligence.
Beth [00:47:00] Have we made progress on that at all? Do you see it? Do you see progress around bio surveillance?
Sarah [00:47:08] Her hesitation is worrying me.
Dr Charity Dean [00:47:09] Yes I do.
Sarah [00:47:10] Okay, good.
Dr Charity Dean [00:47:12] Well, I won't be able to share everything that I know or think,,, because I'm engaged on that front.
Sarah [00:47:18] That's enough for me.
Dr Charity Dean [00:47:19] Okay.
Sarah [00:47:20] That makes me feel better.
Dr Charity Dean [00:47:22] I will say this. The right people, including many of the authors of this book, that you would hope would be engaged around bio surveillance systems and intelligent systems are engaged. And progress is being made. Is it slower than I want? Yes. We needed it yesterday. I mean, we needed it four years ago. These systems should have been built before. It goes back to that old idea of when's the best time to plant a tree? Yesterday or 50 years ago or 100 years ago. When's the second best time? Today. So those solutions are starting to move. The wheels are turning. But I got to be honest, this should have been done decades ago. And it could have been done decades ago.
Beth [00:48:04] What does this group of engaged people need? We have a very action-oriented audience. Are there political pieces that need to move to facilitate this work? Are those obstacles that people can be helpful in just encouraging their representatives to engage on?
Dr Charity Dean [00:48:22] I can't speak on behalf of all 34 co-authors because we would probably all have different recommendations. But I can speak on behalf of myself. And it would be this, that the government is not some magical, smoky figure off in the sky. The government is us. In our democracy, the government is actually us. And so the way to forge solutions is to hold our elected officials accountable. If having read this book, people are fired up and listening to this podcast and say, "Yeah, we need a biosecurity/biodefense system, how come we don't have that? How come that's not in place yet?" That is a great question for your representatives. That is a great way to make your voice heard. Go share your stories with them. You are a small business owner that was devastated by this, go hold your elected officials accountable for starting to put solutions in place because the wheels are turning, but they tend to turn slowly. So there are things people can do and they can get involved in that way. I also think that sharing their stories publicly and a willingness to ask what just happened to us? I know it was traumatic, but are they ready to take a look at it? Are they ready to read this report? Are they ready to share publicly their stories and hold their elected leaders accountable for putting solutions in place? Because if people just move on and forget about this. If they have pandemic amnesia. We are no better off than what happened in 1919, because that's exactly what happened. Everyone just wanted to move on and forget about it. And 100 years later, we were no better off. So the onus is actually on us as citizens to raise our voice, tell our story, ask what just happened, and ask, how are you doing with solutions government? What's moving forward? Tell me about the bio surveillance, biosecurity, biodefense capabilities that are being built right now.
Sarah [00:50:11] Well, I think about a researcher we had on in the show, Becca, early in the pandemic, and I remember her saying, "Hey, we are still studying 1919 as researchers. 100 years later, we're still trying to figure out what happened and what can we learn from it. And so I wonder, like, what are you still thinking about? What questions do you want answered next? It's not as if this book contains every piece of data we have access to. There's always more analysis and more research. And I'm just wondering what you think is the important questions to be asked next, including if the government decides to get off its butt and run its own commission.
Dr Charity Dean [00:50:48] You mean the questions to be asked about 1918 and what happened back then?
Sarah [00:50:52] No,2020.
Dr Charity Dean [00:50:53] Oh, 2020. Shoot, I don't have any more questions, I want solutions.
Sarah [00:50:59] I like it.
Dr Charity Dean [00:51:00] And have dedicated my life to that. I've full time with all the energy I have been working on building solutions because I know enough. Directionally correct information and early warning information is enough to act. So as a frontline disease controller myself, I'm very comfortable acting amid the fog of war with early scattered information that might be directionally correct because speed trumps accuracy. And so, yes, there is a need to study 2020 and answer questions, including origin questions. I do think that question matters and should be answered. And I know there's folks working on it. But for me, personally, I'm far more interested in getting into building solutions. I want to be in that fight, and I'm heartened every day by the people that work beside me in biosecurity/biodefense who are equally passionate about building solutions, because there will be another one. Just looking at some of the data over the global biological threats that have come up over time over the last hundred years or 200 years, the velocity of these things has sped up. I don't believe it's going to be even another 10 years before we have our next global biological threat. And we're nowhere near having the solutions and systems in place.
Beth [00:52:20] Meanwhile, where are we with Covid now? How do you think about the stage of the war that we're in? I think about all the wars that never really ended. There weren't treaties that, people didn't put their arms around, they moved into new phases. So I wonder how you think about our current phase with Covid.
Dr Charity Dean [00:52:37] That's a great question. So I'll start from kind of a microbiological perspective. Again, what do pathogens do? What do viruses do? They evolve to select the most fit version of themselves. We know that that's what they do. And so this virus has continued to evolve to escape natural immunity. We need our natural immunity. Folks have been infected and their immune system builds up a natural protection for them. The virus is evolving to escape natural immunity. It's also evolving to escape vaccine immunity. And the name of the game always is we have to evolve our medical countermeasures and vaccines faster than the virus evolves. We're still behind. We're behind. And so the vaccine is still incredibly important. Natural immunity plays a really important role. That's why we're not seeing the hospitalizations and the deaths numbers where they were in 2020. But I'm worried about the direction this virus is headed. It's with us for the long run. And as it continues to evolve and select more versions of itself, I guess the question for us-- and there's people smarter than me working on this in the vaccine space-- how long might it be until we have a multivalent vaccine that would be able to cover all the different new variants that come out, future variants that will evolve. There's really smart people working on that in government and in industry. So that's the good news. I think the bad news is this virus is with us for the long run. It will continue to evolve and mutate. And as it looks right now, it's continuing to select more fit versions that escape natural immunity, vaccine immunity, and yet we got to keep fighting with the tools that we have. It's important for folks to get vaccinated, especially those that are vulnerable. And I make sure my parents are up to date on their Covid vaccines. They're in their 70s, and I love them, and I'd like them to stay around a bit longer. So in kind of a war framework, you're right, this is going to be a war that stretches on. The fatalities are less. The overall impact may be less because the fatalities are less. We're not shutting down businesses today, or everyone's staying at home with masks. But it's never going to go away. And I think that's a real question for us both in the medical health and intelligence government space. What will we do differently for the next one? And what can we even do differently now? Whether it's multivalent vaccines that are able to address all the current variants at once, including future variants. Containment. We must preserve the option of containment at the very beginning of these outbreaks first happening, and that is a capability that we do not have today.
Sarah [00:55:24] I found the vaccine discussion some of the most helpful in the book. I didn't know I'd heard two more beautiful words together than Vaccine Library until I read about it in this report. I was like, that sounds really wonderful. I am so glad very many smart people are working on that, and we're just both so grateful for the work of this report. And to all of you that I know, this was, I'm sure, a long and arduous process, but I think the product is incredibly, incredibly valuable. I have encouraged everyone I know to read it. We've encouraged our audience to read it. So just thank you so much for your work on the report, your work during the pandemic, and for coming on our show.
Dr Charity Dean [00:56:03] It's a pleasure. It's a pleasure. All of us that participated in the report truly felt like this was what we did in service to our country. I didn't get paid for my participation, that was voluntary. And it was an honor. It was an honor to be one of the co-authors. And we really hope that people read it and take action based on it, even if taking that action is simply asking themselves, how can I be part of this? How can I get in the fight? Whether it's contacting my elected officials or getting involved locally, what can I do to be part of the solution and not just move on and forget everything happened?
Beth [00:56:51] Thank you so much to Doctor Charity Dean for joining us. We are so grateful for her time and expertise. If you liked this episode or found it helpful, we hope you'll share it with someone. You can just text it to them, put it in their DMs, give them a link. Because making it easy for people to click really helps them and it helps us. And if you are in a workplace or organization or space struggling with difficult conversations and communication, we'd love to come help you with that. So please do reach out to us Hello@pantsuitpoliticsshow.com to learn more about booking us for speaking events. We cannot wait to be back with you next week. There's lots to talk about, including this TikTok bill, so we'll be here to do that and discuss anything else that develops over the weekend. Until then, have the best weekend available to you.
[00:57:30] Music Interlude.
Sarah: Pantsuit Politics is produced by Studio D Podcast Production.
Beth: Alise Napp is our managing director. Maggie Penton is our director of Community Engagement.
Sarah: Xander Singh is the composer of our theme music with inspiration from original work by Dante Lima.
Beth: Our show is listener-supported. Special thanks to our executive producers.
Executive Producers: Martha Bronitsky. Ali Edwards. Janice Elliott. Sarah Greenup. Julie Haller. Tiffany Hasler. Emily Holladay. Katie Johnson. Katina Zuganelis Kasling. Barry Kaufman. Katherine Vollmer. Laurie LaDow. Lily McClure. Linda Daniel. The Pentons. Tracey Puthoff. Sarah Ralph. Jeremy Sequoia. Katie Stigers. Karin True. Onica Ulveling. Nick and Alysa Villeli. Amy Whited. Emily Helen Olson. Lee Chaix McDonough. Morgan McHugh. Jen Ross. Sabrina Drago. Becca Dorval. Christina Quartararo. Shannon Frawley. Jessica Whitehead. Samantha Chalmers. Crystal Kemp. The Lebo Family. The Adair Family.
Sarah: Jeff Davis. Melinda Johnston. Michelle Wood. Nichole Berklas. Paula Bremer and Tim Miller.