Watch the AMA's daily COVID-19 update, with insights from AMA leaders and experts about the pandemic.
In today’s COVID-19 Update, Tom Frieden, MD, former director of the CDC and president and CEO of Resolve to Save Lives, discusses the importance of assessing your personal COVID-19 risk and the steps we need to take now to make the world more pandemic-proof.
Learn more at the AMA COVID-19 resource center.
- Tom Frieden, MD, former director of the CDC, president and CEO, Resolve to Save Lives
Unger: Hello, this is the American Medical Association's COVID-19 Update. Today we're talking with Dr. Tom Frieden, former director of the CDC and president and CEO of Resolve to Save Lives in New York, about where we are in the pandemic and what's coming next.
I'm Todd Unger, AMA's chief experience officer in Chicago. Dr. Frieden, obviously, I see you a lot in the press lately and I'm even seeing you a lot on LinkedIn and really enjoying your posts because you do a great job of helping people make sense of the numbers and providing guidance. I was wondering, do you see this as kind of a void in our system and where do you see your role in all of this right now?
Dr. Frieden: Well, fortunately it's a shrinking void. If you see the difference between the prior administration and the Biden/Harris administration, now you're getting real time, reliable information from your government. So that means that there's less that I feel I have to do to fill that void. And that's really reassuring. I hope over time, I'll be able to appear even less in the media, would be my goal. Because really our work at Resolve is to partner with communities and governments around the world to advance public health programs.
But COVID is a remarkable challenge and just keeping up with the scientific advances is more than a full-time job. Keeping up with the media directions is another full-time job. And then advising institutions ranging from professional sports leagues to universities to other institutions, to state and local governments to other governments around the world is another full-time job.
So there's a lot of work to be done, to respond to COVID. But what's really striking to me is how quickly things change and how important it is to be situational in how we respond. To see what the best available information is and then to act based on that best available information, understanding that we may have to adjust that action later based on new information. What we're seeing today is information about what happens with the virus, variants and the vaccine. And that's still an unfolding story.
Unger: Well, let's talk more about that because obviously that is a curve ball thrown into a situation that was already very complex. What do you see coming? I see variations between optimism and real fear about what a variant could do in this delicate period coming up here in March and April.
Dr. Frieden: I see we have really a few big unknowns. The first unknown is will we have a fourth surge in the United States? And really the answer to that question is up to us. That's not about variants. What we've seen from the U.K., from Ireland, from Portugal and Israel and elsewhere is when the more infectious variant comes in you can have explosive spread. And yet in all of those countries, when you do the right thing with masking and distancing, the virus recedes.
And so we have to keep up our guard, keep up our masks and we can avoid a fourth surge, which will also not only save lives and help us get back to the new normal, or get to the new normal faster, it will also reduce the chances that the virus will mutate in ways that evade our natural immunity or immunity from vaccines.
That's the short term unknown. The longer term unknown is how good, how long lasting, how complete is the immunity from vaccines and natural infection going to be? And will the variants allow reinfection? Recently we've seen some concerning information. In a best case scenario, you need the vaccine series and you're protected for life, even if the vaccine changes.
That's not too likely, but it's possible. In the worst-case scenario, the vaccine-induced immunity doesn't last very long, partly because it fades, or partly because vaccine escape mutants are able to evade our defenses. And I think the truth is going to be somewhere between those two. I tend to be optimistic. I think we've got a really good vaccine. I think the mRNA platform is incredibly powerful and we're going to be able to stay ahead of the virus, but only if we work together.
Unger: Well, you've said that, quote, "This is no time for complacency." But back to what you were talking about before and what it really takes to prepare for these variants, are you concerned right now with the lifting of things like mask mandates, that people are going to get mixed messages about what's going on right now?
Dr. Frieden: I am really worried. Right now cases are plummeting throughout the U.S. We've gone from 300,000 cases a day to 50,000 cases a day. So we're down at really a small fraction of what we were at just six weeks ago. However, we're still probably three times higher than where we could do effective disease control with a very effective containment strategy that is to bust the clusters. To make sure that when it starts spreading, we stop it from spreading. We can do that, but only at much lower levels even than we're at now.
So it's no time to let down our guard, but we've learned a lot. Outdoor activities, very safe. Masking, very effective. So there's lots that we can do to control the virus, the virus outnumbers us but we should be able to outsmart it.
Unger: What is the level at which we need to get down to for those measures to be really effective that you were referring to before?
Dr. Frieden: There's no hard and fast number, but my rough guess is that if we have more than about 10 or 15,000 cases a day in the country, it would overwhelm even the best health departments with unlimited resources. It's a really big job to investigate every single case, to figure out where it came from, who might have been exposed there, to stop that from spreading, to warn the people downstream, if you will.
That's a big job and I just can't imagine even the best health departments in the world keeping up with more than 10 or 15,000 cases a day in the U.S. And ideally a small fraction of that. Other parts of the world, they have one case or 10 cases, and they shut whole cities. We've gotten inured to the level of infection. And as the vaccination continues to roll out and supply improves, we'll be able to protect much better. But we're still going to have to do a really good job at finding cases quickly and stopping them from spreading explosively.
Unger: Resolve to Save Lives has partnered with Johns Hopkins and the New York Times to help people assess their personal risks. Can you tell us more about this initiative and why this kind of information is so important right now?
Dr. Frieden: There has been too little information for people on what is the risk in their community. In essence, how hard is it raining COVID in my community? And so what we did with the New York Times and Hopkins was to put together a way of tracking the level of infection in the simplest most understandable way. Looking at extremely high risk, very high risk, high risk, moderate risk, low risk.
And what that shows is that if you look at that data from back in September, it was bad but not terrible. If you look at that data from January, it was terrible. And if you look at it from today, it's a lot better than it was six weeks ago, but a lot worse than it was in September. We are not out of the woods. We're going in a good direction quickly. That means we need to keep it up. If we let down our guard, the risk is we'll have a fourth surge, the virus could come raging back with lots of deaths and the potential for more dangerous strains of the virus.
Unger: Yeah. I went to the New York Times and I checked the data for Chicago. And despite the fact that those cases are declining, and we're still in "high" territory and there's a 5% positivity rate. For someone living here, how would you interpret that?
Dr. Frieden: It's not safe out there yet. Continue to wear a mask, continue to limit the time you spend indoors with people who are not in your family.
Unger: All right. Well, let's talk a little bit about vaccines, you mentioned before. I guess you might describe the rollout as being a little bit rocky. Where do you see the improvement here and how do we get to the goal of 3 million doses a day from where we are right now, which I think is around 1.75?
Dr. Frieden: I think what we're seeing is a steady improvement. As people get used to dealing with vaccines that are complicated to deal with the major rate limiting step, still, is scarcity. There isn't enough vaccine out there. If you think about it, we're vaccinating about 1.7 million people a day, and they're sending out 10 to 12 million now, 13 million doses a week. So nearly all of the doses that are getting sent out are getting given.
The big problem is equity. Scarcity is the enemy of equity. Black and Latinx people in the United States have two or three times the death rate of white people, and yet are half as likely to get a vaccine. And although there may well be some vaccine hesitancy for perfectly understandable reasons, the bigger problem is a lack of access. What we see is even when there are pop-up vaccination clinics in poorer neighborhoods, it's the rich folks going to those communities to get their vaccines.
We have to have a concerted effort to improve the equity of vaccination delivery. That means having innovative ways of registering people. I know of one community where they're registering by zip code. So there are slots for each zip code, and that assures that people in poor zip codes are going to have an equal chance of people in wealthier zip codes of getting vaccinated. That's a good example.
There are community organizations that can run pop-up centers and be entrusted with slots to be given to people who are at higher risk. The disproportionate burden of COVID in different parts of the country and different groups in our society means there has to be disproportionate resources with more resources, for those who are being hit harder by the virus.
Unger: I really like how you said that, that scarcity is the enemy of equity. And I think you have to probably factor in urgency on top of that, given where we're staring down at the issue with variants. How do you balance those variables in the equation?
Dr. Frieden: I don't think there are any shortcuts to reaching out to communities doing what we call in global health "micro-planning," who's going to get vaccinated, where, by whom and when? And maybe we should have in faith venues and other places every Saturday, every Sunday, 500 slots. And think carefully about how through health care providers, through nursing home, through pharmacies, including local pharmacies and through pop-up and points of distribution, how we can really not only maximize speed, but also correct the really horrifying inequalities that are being exacerbated by the pandemic.
Unger: I guess you could definitely say that we were caught unprepared in many ways for things that we might've been able to think through in regard to a pandemic. You recently published an article in the Wall Street Journal on how to prevent the next pandemic. Can you share some of the highlights of your thinking there?
Dr. Frieden: Well, first I think we need a galvanizing global goal and we propose 7-1-7. That every community and every country in the world should be able to find an outbreak within seven days of its emergence, investigate and report it within one day after that, and establish effective control measures within seven days after that. With those control measures to be defined differently for different microbes.
That kind of goal, of which we're not close to now globally, could lead to substantial investments in and accountability for improvement in our ability to find, stop and prevent health threats from around the world. That's going to require stronger global institutions. That's going to require another $5 or 10 billion a year in spending specifically on preparedness globally. That's going to require a more effective World Health Organization, that's more immune from political pressure.
That's probably going to require doing something like opening a preparedness window at the Global Fund for AIDS, TB, Malaria. It's a very effective organization that can move resources quickly and support governments and countries.
Now there's also a need for much stronger technical support, including support from among lower income countries. Rich countries don't have a monopoly on knowledge. In fact, if you look at countries such as Senegal and Liberia, Nigeria, Ethiopia, they've had very effective responses to the COVID pandemic. They're much more familiar with contact tracing. They're much more familiar with mass vaccination programs. They've done border controls and quarantine for many years. So they have many needs resource and human resources, but there is also a lot of expertise. And part of the role of all of us globally should be to strengthen the hands of global health experts and leaders around the world so that we can get to a much safer global reality.
Unger: Well, that definitely makes sense. And hopefully we'll have learned the lesson from the situation that we're in right now and be prepared for the possibility of a next one. Thank you so much, Dr. Frieden for being here today and all the work that you're doing. That's it for today's COVID-19 Update. We'll be back soon with another segment. For resources on COVID-19 visit ama-assn.org/COVID-19. Thanks for joining us and please take care.
Disclaimer: The viewpoints expressed in this video are those of the participants and/or do not necessarily reflect the views and policies of the AMA.