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Call For Public Health Investment In Next Congressional COVID-19 Aid Package


What will it take for Americans to get back to work? Two veteran voices in American health care are offering answers. They are sending a letter with a plan to congressional leaders today. One of the two is Dr. Scott Gottlieb, a former commissioner of the Food and Drug Administration under President Trump. The other is Andy Slavitt, who led the Centers for Medicare and Medicaid Services under President Obama. Both are advising current officials. And they've offered what is, in effect, a bipartisan plan, which NPR has obtained. Dr. Gottlieb and Mr. Slavitt, thanks to both of you for joining us.

SCOTT GOTTLIEB: Thanks a lot.

ANDY SLAVITT: Thank you.

INSKEEP: And, Scott Gottlieb, maybe we should start with you. You write that the key to this whole thing is testing and contact tracing but on a massive scale. What's it going to take?

GOTTLIEB: That's right. And thanks for having us this morning. What we envision is after we get through this phase where we quell the current epidemic and we get to more of a steady state, if we're able to turn the corner, there's still going to be smoldering infection. And we're going to have to have an aggressive system in place to try to identify positive cases through testing. And when we do find people who are infected with coronavirus, we have to have a system in place to allow them to self-isolate so that they don't continue to spread infection. That's going to require us to hire many more public health workers to do the contact tracing, basically the blocking and tackling of public health work, where you identify people, and then you go out and talk to them and then interview people who may have been in contact with them and offer them testing. That's what we typically do if we have an outbreak of measles or multidrug-resistant tuberculosis. We do this all the time. We also did this at the outset of coronavirus, but what happened was the infection became so pervasive that it exhausted our ability to isolate individual people.

INSKEEP: Well, let's talk about that because there were just too many infections and not enough people. And now you say you would need to hire - the country would need to hire, you estimate, 180,000 people for contact tracing. And I was thinking that's larger than the number of U.S. troops in Iraq at the height of the Iraq War. Is that possible to ramp up that many people that quickly?

GOTTLIEB: Well, I'll comment, then I'll turn it over to Andy, but we think it is. There's different estimates in terms of the number of people that would be needed to do this work. Some estimates at the low end estimate around 100,000 people. At the high end, some estimate up to a quarter of a million people. This was sort of a middle-of-the-road estimate based on analysis that we had done and had worked with some people to develop. I think it's possible to hire this number of people. We already see the states making efforts to bring on thousands of new public health workers to do contact tracing. So when you amortize this number over 50 states, and especially some very large states, we're going to need this number of people if we want to enter into the fall with the kinds of resources we need to try to trace infection to prevent large outbreaks from happening.

INSKEEP: Andy Slavitt, what about the other part of that? He mentioned self-isolation. What is wrong with sending people home to self-isolate, which is what people have typically been doing?

SLAVITT: Well, people can. If people have a safe place to go home to, if they have a spare bedroom, they have the room, that's great. But it's important that people not reinfect their family members, particularly if they're out in the world. And so some people just can't do that safely. And for people who can't self-isolate, we're offering in our letter that we use some of the many spare hotel and motel rooms that exist around the country as a place that they can voluntarily go for a couple of weeks and get better and heal. It's purely voluntary. But I think for people who can't follow the guidelines that we - people strongly recommend, it's really important. We've got to remember that not everybody lives in the same type of living situation that allows them to do that.

INSKEEP: You know, I've heard - and I'll ask both of you this - I've heard so much commentary about trying to get back into an area where there can be testing and contact tracing and the various outbreaks of the disease can be stamped down and a sufficient number of people can be sufficiently isolated that it doesn't spread nearly so quickly. Sometimes, though, it's noted that perhaps we've gone way beyond that. It's just too far spread, too deeply spread in the population to do this. Is this even an achievable goal? Even if you stood up those 180,000 people, are you sure that they would be on top of the increasing number of cases as the economy begins to open back up?

GOTTLIEB: Well, look; nothing's foolproof. What we're going to be doing as we enter into the fall, in particular, as coronavirus starts to collide with flu season and we face the risk of large outbreaks and maybe another epidemic heading into the winter, what we're going to be trying to do is get ahead of this and put in place enough layers of protection that you mitigate spread. We're never going to be able to reduce all spread. There's going to be infection that circulates in the background, but you want to have as much protections in place, as much layers in place to try to contain outbreaks where you can, reduce spread where you can, keep the level of transfer hopefully below the point at which you have another out of control epidemic. And getting in place contact tracing, trying to isolate people who have the infection who are actively infection, have them self-isolate at home or at a facility, at a hotel room that might be provided to them, that's going to ultimately reduce the amount of spread. It's not going to fully eliminate it.

INSKEEP: What else is it going to take to be safe as the economy reopens? And obviously, this is an urgent question. Georgia just today is reopening dine-in restaurants and theaters. Waffle Houses are opening up in Georgia. There are other kinds of businesses open in Georgia. There are other places, like South Carolina, doing this. And obviously, everybody in every state in the union would like to go in that direction. What's it going to take to do that safely?

GOTTLIEB: Well, I'll let Andy take a shot at it (laughter).

INSKEEP: Go for it.

SLAVITT: Yeah. Well, look; everybody would like to get back to some semblance of normal. I don't think this is a situation where we have some states that are and some politicians that are eager to and other states that aren't. The question is, how do you do that safely? And I think it's not a question just for politicians. It's a question for American families. Even if states like Georgia and others open up certain activities, we're not finding that people are necessarily jumping back in. People, by large margins, according to a recent Kaiser Family Foundation poll, still believe that social distancing and some amount of staying at home is going to continue to be necessary. It's not going to be possible for everybody. And I think what we'd ask is that people understand that there are essential workers, there are health care workers - those folks don't have any choice. And as you make your own choices, we've got to be very careful to make sure that we're not endangering others.

And so this plan I think is not - as Scott said, it's not intended to eliminate the situation we're in. What we're going through now, it'd be the equivalent of a forest fire. What we want to get to is a position where we have a series of small campfires. And every time one opens, we can put it out and not have it open into a forest fire.

INSKEEP: Well, Andy Slavitt...

GOTTLIEB: Just to...

INSKEEP: Oh, go ahead. Go ahead, Scott Gottlieb.

GOTTLIEB: Oh, I was just going to pick up on the point that Andy made because I think it's a really good one. You know, ultimately, the states can start to reopen activity. Georgia made the decision to reopen certain activities, which I disagreed with the kinds of decisions that were made. But ultimately, states are going to do these things. But consumers aren't going to come back until they have confidence that we have this epidemic under control. So I think the best thing we can do to restart the economy is get control of this epidemic.

We're at a point right now where we're seeing cases across the country plateau, but we still have 30,000 cases a day that we're recording. There's many more that we're not capturing. We're still having 2,000 deaths a day. So we've plateaued, but we haven't really seen the sustained declines that we think we need in order to really safely start to restart economic activity. In fact, really, when you look at it, only about five states have shown sustained reductions in new cases that meet the criteria set out by the administration in terms of when you would contemplate restarting activity. So the best thing we can do to get consumers back and get the economy vibrant again is give people confidence that we've controlled this epidemic, the virus isn't circulating widely and people's risk of contracting it if they go out is low again.

INSKEEP: Andy Slavitt, let me come to you first here in this final key point. You come out of a Democratic administration. Dr. Gottlieb comes out of a Republican administration. What, if anything, is a partisan difference here, a genuine difference of opinion about the role of government or anything else that would stand in the way of a coordinated plan to reopen the economy?

SLAVITT: Well, look; first of all, I think we're at a moment in time when if we can't be bipartisan now when there's a threat to everybody - remember; Republicans and Democrats can spread this virus among each other; it's not just something that stays within political parties - when can we? Of course, the political parties in Washington have their realities, and I think they're going to look at things through their own lenses. I think we tried to incorporate a lot of that thinking in here. I think, as Scott points out, that some of the important civil liberties are vital here, making sure that we do this fiscally sound, so we do this...

INSKEEP: Oh, civil liberties, meaning you're not going to do a lot of mandatory quarantines. You'll try to make them voluntary when you can.


INSKEEP: That sort of thing. Go on.

SLAVITT: Right. We've got to respect people's civil liberties, and we've got to also make sure that we're being fiscally smart so that if people - states ask for money and they don't use it productively, they have to give it back to the federal Treasury. And I think those are important concerns for conservatives. And I think they're probably important concerns for many Democrats as well. And on the Democratic side, you know, I think they have a strong interest in making sure that this gets distributed equitably. I'm sure many Republicans do as well. But just testing well-off populations isn't going to meet that hurdle. I think Scott and I and the 14 other people that signed this letter believe that this can be done in a way that benefits everybody.

INSKEEP: Scott Gottlieb, what partisan differences do you see that need to be managed?

GOTTLIEB: Well, I'll just say on the political right, I think that there's concerns that doing contact tracing at scale and asking people to self-isolate if they have infection can infringe on people's individual personal liberties and their personal freedoms. I don't see it that way. This is a core part of public health tools that we've used in the past to control other epidemics. If we don't do this here, then we're not going to manage to mitigate the risk of epidemics heading into the fall. I think what the criticism that I hear on the political right is, well, this is going to be so pervasive. How could we possibly keep up with it with the traditional tools of contact tracing and self-isolation? I don't believe that that's the case. I think we can keep up with it.

INSKEEP: And do you think that people on the political right are prepared for an expansion in government power to get it done?

GOTTLIEB: I don't know that it's necessarily a question of the expansion in the government footprint to try to accomplish this. I think it's a question of if you're doing this at scale, if you have many people doing contact tracing, is that going to start to infringe on people's personal freedoms? Are you going to have a lot of people running around saying, you have to self-isolate, you have to self-isolate? I don't think we're going to be at that point. I think if we get this right, if we quell this epidemic now and we get these tools in place, we can keep transfer of this infection at a level low enough that it doesn't interfere with people's liberties.

INSKEEP: Dr. Scott Gottlieb, formerly of the FDA, and Andy Slavitt, former acting administrator for the Centers for Medicare and Medicaid Services, thanks to you both.

GOTTLIEB: Thanks a lot.

SLAVITT: Thanks.

(SOUNDBITE OF MUSIC) Transcript provided by NPR, Copyright NPR.

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