Biden COVID Transition Team Advisor Dr. Celine Gounder on Race Against Variants

Dr. Celine Gounder - 20210329GounderXM

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Marianne O’Hare: Welcome to Conversations on Health Care with Mark Masselli and
Margaret Flinter a show where we speak to the top thought leaders in
health innovation , health policy , care delivery and the great minds
who are shaping the health car e of the future. This week Mark and
Margaret speak with Dr. Celine Gounder I nfectious Diseases Expert,
epidemiologist and member of President Biden's Transition Advisory
Task Force on COVID - 19. She and others helped craft the policies that
led to the drama tic uptick in vaccinations across the U.S. Like many
other experts, she warns there's a threat of variants driving increased
cases of COVID - 19 .

Lori Robertson also checks in , the Managing Editor of FactCheck.org
she look s at misstatements spoken about heal th policy in the public
domain , separating the fake from the facts, and we end with a bright
idea t hat’s improving health and well being in everyday lives. If you
have comments please e - mail us at [email protected] om or find us
on Facebook , Twitter , or wherever you listen to Podcast and you can
also hear us by asking Alexa to play the program. Now stay tuned for
our interview with Dr. Celine Gounder here on Conversations on
Health Care.

Mark Masselli: We're speakin g today with Dr. Celine Gounder , who served on the
Biden administration's COVID - 19 Transition Task Force. She's an
Infectious Disease Expert and Epidemiologist at New York's Bellevue
Hospital and Professor of Medicine at NYU.

Margaret Flinter : Dr. Gounder was the director of delivery for the Gates Foundation's
HIV TB global response initiative. She's written extensively on
infectious disease for the Atlantic, The New Yorker, The Guardian, The
Washington Post, and is also a Medical Analyst for CNN, Dr. Gound er
Welcome to Conversations on Health Care today.

Dr. Celine Gounder: Great to be here.

Mark Masselli: Yeah, that's great. You know, we're in this race right now, between
the vaccinations and the variants and COVID - 19 cases are in rise here
in the United S tates, and elsewhere. And as we look at the United
States, and places like Brazil, and Chile in Europe, what is most
worrying to you about the plasticity of SARS COVID to as it continues
to drive more troubling variant activity in the pandemic, I saw that Dr.
Walensky from the CDC was talking about sort of being both scared
and an impending doom on the horizon.

Dr. Celine Gounder: Yeah, first one pattern that we've seen, it's that when you have a
plateau in cases, that is not followed by a decrease that is followed by

Dr. Celine Gounder - 20210329GounderXM

an increase, and then a spike up. And that is precisely what we are on
the tipping point of right now. Another key pattern we've seen
throughout this pandemic is that the United States generally follows
Europe in its transmission of the virus b y about three to four weeks.
And so we've seen the spread of the B - 117 variant, which first
emerged in the UK, first in the UK, then elsewhere in Europe, and now
to the U.S. , and that strain is now becoming the dominant strain in
the United States, it's al most probably at this point approaching 50%.
And what's really important about that strain to know is that it is
more infectious. So it spreads more easily from person to person, it's
more virulent, so it causes more severe disease. And we've certainly
see n at least in the UK, and Europe, younger people end up in the
hospital sick with this particular variant.

You mentioned plasticity, what we've realized over the course of this
pandemic, is that the virus can actually mutate pretty significantly
with respe ct to the spike proteins. So those are the proteins on the
surface of the virus that the virus uses to penetrate our human cells.
And it's actually able to mutate in that spike protein pretty
significantly and still remain able to replicate very often when you
have mutations, that's a dead end, the virus is no longer fit. It's sort of
like a congenital abnormality. And so the fact that it's been able to
mutate and get ahead of us has been, you know, really dangerous.
And so I think, you know, another lesson I would add to that list is,
you know, all bets are off. What we thought we knew, based on other
infectious diseases may not always apply with the Coronavirus and,
and, you know, we shouldn't be overly confident in being able to
project where things are h eaded.

Margaret Flinter: Well, Dr. Gounder I think we've maybe indulged in a little bit of feeling
good about the success of the COVID vaccination effort here in the
United States since January and since President Biden took office. But
I think as you've p ointed out, you know, it's good news a 100 million
people have been vaccinated, but that leaves 200 million people
who've not been vaccinated. And we know that the success has not
been similar to the U.S. in some of the developing countries around
the worl d . It seems it's in our best interest for this to be a global
vaccination effort, not just a U.S. vaccination effort. What worries
you, in addition to the humanitarian concern about other countries,
just not having this, this headstart on getting their peo ple vaccinated?

Dr. Celine Gounder: Well, as we've learned, what happens halfway around the world can
have very real implications for our health, our public health, our
economy. And so when you allow the virus to spread anywhere, it
doesn't have to just be in the U.S. when the virus is spreading and
replicating elsewhere, it has the opportunity to mutate, it has the
opportunity to evolve, to where it can escape both our immune

Dr. Celine Gounder - 20210329GounderXM

responses to natural infection as well as our immune response to the
vaccines. An d it should not really be much of a surprise that the places
-- the more infectious variants or the immune evasion variants are
arising from our countries where they've allowed the virus to spread
like wildfire. So the UK, South Africa, Brazil, and so that really is the
substrate for the development of these more dangerous variants. So
it's really in our own interest to make sure that the conditions for that
kind of viral evolution are not there and not anywhere.

Mark Masselli: You know, I want to pull the thread on that as well, because it seems
to me that we also have to start changing our message. Certainly the
Biden team has been preaching, National Safety compliance and
vaccine acceptance. But we're still feeling the after effects of the
previous admini stration , which has led to health protocol resistance in
many parts of the country. How do we leverage a better pandemic
messaging, also, when things are changing, but you know, it's -- it's
not what we've projected out? What changes need to be made in the
administration's call to action to Americans?

Dr. Celine Gounder: Well, I think untold damage was done over the past year, with respect
to science, communication, and public health communication. And I
really think the message to everyone should be that y ou never
politicize the response to a public health crisis. And that includes the
communications around it. In a public health crisis, the job of
politicians is really to step out of the way and you empower , you
marshal the workforce, the supplies, the fun ding necessary for the
experts to do their job, you know, but you really should allow
healthcare providers, public health officials, and scientists to be the
face of the response , to be communicating about the response and i n
a way that's really focused on just the welfare of the people.

Margaret Flinter: You know, Dr. Gounder , I was reading some of your background, and
I'm really impressed and happy to see that it seems like wherever you
are in the world trying to deal with these major health issues, you t ry
and get out and talk to the people in the communities who are
affected by it. And in fact, prior to the pandemic, you were doing that
I think here in the U.S. embarking on a ill health tour, kind of a
journalistic endeavor, as well as a medical one to e xplore some of the
root causes of the hotspots in the country, particularly affected by
disease or poor health or poor health outcomes. How do you think
this pandemic might maybe hopefully accelerate our ability, our
health system ’ s ability to recognize th at and to address some of these
root causes and drivers of poor health outcomes? Is there a -- can we
look forward with some optimism that we will take what we've
learned and use it to maybe lift the health of people across the US?

Dr. Celine Gounder: I am optimistic. I do think this has been a wake up call for a lot of

Dr. Celine Gounder - 20210329GounderXM

people who might have heard of what we call the social determinants
of health but just didn't really focus on that or didn't really think it
was something that was part of their job to addres s. And I think this
has really highlighted the importance of that kind of thinking that we
need to be understanding of how, for example, structural racism has a
very real impact on health. You know, how health reform and
Medicaid expansion -- what that ha s meant in different communities
during the pandemic, who was able to access testing or care and who
wasn't and why . And finally I think we've also seen some of the
vulnerabilities around transportation, especially in rural areas, and the
need to bring ser vices to the people not having to wait for people to
seek out those services to brave the hunger games of online
appointment making, but really to bring vaccination testing, etc , to
people where they are.

Mark Masselli: We're speaking today with Dr. Celine Gounder , Member of the Biden
Administration's COVID 19 Task Force and an internist, Infectious
Disease Expert , writer and CNN medical correspondent, she hosts
several podcasts, including at epidemic podcast, a weekly show on
public health. You know Dr. Ga nder, I'm sure a lot parents ’ ears
perked up, as you said that B - 117 also was perhaps impacting children
a little more, and you know, the CDC has recently released new
guidelines for returning children back to the ir classrooms. But you've
warned that back to school efforts will require more stringent
parameters to safely return. And I'm wondering if you could share
with us what teachers and staff need to do in addition to getting
vaccines. Obviously, kids won't be vaccinated for a while at least those
under 16. In many schools right now, lack of proper ventilation. What
are your concerns? And what guidelines are you seeking?

Dr. Celine Gounder: I do think the CDC guidelines with respect to having students three
feet apart instead of six feet apart are reason able based on what
we've seen, with respect to transmission. And that really points to the
bulk of the transmission probably being airborne through aerosols, as
opposed to being through droplet spread, or direct contact. That said,
when you increase the de nsity of people in a classroom, your
probability of any one of those people being infectious it being
possible that they could infect others, that probability goes up. And so
that is still something that you really need to pay close attention to.
And we re ally do need to be doing at least surveillance testing in the
schools. So that we have our finger on the pulse of where things are
headed, and whether we need to tighten up measures. I think
ventilation is very important. In some places that could be as si mple
as opening a window, New York City, the Department of Health and
the Department of Education teamed up to inspect classrooms and
see what would work to meet certain thresholds for ventilation and in
some cases, many cases, opening a window was enough. But that's

Dr. Celine Gounder - 20210329GounderXM

not always going to be possible. And so in some settings you might be
putting in place for example, one of those HEPA air filtration
machines.

Margaret Flinter: Well, while we've been so focused on the COVID pandemic, one of the
things we're ve ry aware of is that the other epidemics that were very
much in our consciousness and at the forefront of our work, haven't
gotten better. And certainly, the opioid use disorder crisis and deaths
by opioid poisoning and overdose have continued to, I think, mostly
climb. And then of course, the gun epidemic, gun violence epidemic is
just right, in our faces and in our hearts this week. I know these are
is sues of concern to you as well. Can you share a little bit with us
about where you think this administrat ion and public health will go in
this year to try and make progress on those two fronts, even while, of
course, the COVID pandemic continues to consume probably much of
our attention?

Dr. Celine Gounder: Yeah, so our incoming Surgeon General, Dr. Vivek Mur thy, is very
interested in all of the issues you mentioned, whether that's mental
health, substance use disorders or the gun violence epidemic. And so I
do think this is going to be front and center for him as he comes into
office and gets to work. There's no question that there is an
interaction among these different crises with respect to the opioid
overdose crisis. We know that there's a connection between
economic insecurity and what some have dubbed these deaths of
despair, so people dying of an overdo se , of suicide. And, you know,
that also ties into gun vio lence because two thirds of gun - related
deaths are suicides. So there's no question that some of the
desperation from an economic perspective that's been driven by the
pandemic is also driving those two other epidemics. I think the other
issue with opioids is that because people have been isolated they
have not had as good a access to health care, they may not have been
able to, for example, attend group therapy or access opioid
substitution therapy and the like, over the course of the pandemic the
way they normally would. And one of the other pieces of advice we
give to people is if you are going to use you do so with somebody else,
so that if somebody overdoses there’s someone there to call 911. And
that's also really hard to do when people are socially distant.

Mark Masselli: You know, Dr. G ou nder, we've had Dr. Fauci on a couple of times in
this last year. And he's really talked about how the global health and
scientific community have really come together and collaborated in
ways they've never had before. And you're presenting this week at
the wired health conference and I’m wondering what kind of lasting
health transformation do you en vision emanating from this crisis,
especially as these new scie ntific and digital platforms for research
and disease surveillance scale up ?

Dr. Celine Gounder - 20210329GounderXM

Dr. Celine Gounder: I really hope we invest much more significantly in our public health
infrastructure. And so that includes everything from your labs, and
the workforce to staff those labs, bioinformatics is really key here too,
because to do that genomic analysis, where we're analyzing the
different variants, that's actually quite technical computer science
kind of work. And so I really would like to believe that we will invest in
that kind of capacity. One of the other areas where we've seen with
respect to health tech, there being some major shortfalls is just in our
data collection systems , b eing able to analyze that data in real time
across the country. Some health department s are pretty well funded,
have reasonably sophisticated systems . Others, I've even seen some
that were still operating on MS DOS, you know, which is going back 20
years plus, right. So, you know, I would really like to believe that we
invest in and take se riously the need to have the most up - to - date
systems in public health, just as we do in many other industries.

Mark Masselli: You know, just one last on the variant issue, while the United States
may be doing a great job , you sort of suggest there’s a petr i dish out
there in the rest of the globe, where this virus may not see a vaccine
for years. What's the worry that it mutates past our current vaccine
capabilities?

Dr. Celine Gounder: Well, I'm not sure that I would say th at U.S. is doing a great job on
va rian ts. We're doing a great job on vaccination. We have scaled up
our surveillance for varian ts s over the last couple of months, but
we're still not really where we need to be yet. So I think that's one
issue. I am very concerned that the virus may well c ontinue to mutate
that either the B - 1351 or the P - 1 variants which emerge d out of South
Africa or Brazil could mutate further to where the immune response
to the vaccines is no longer protective. And there could be other
variants , could be emerging elsewhe re as well. So that really is
something many of us are concerned about and worried about.

Mark Masselli: We continue to follow your work. Thanks so much for joining us
today.

Margaret Flinter: We've been speaking today with Dr. Celine Gounder internist,
ep idemiologist and member of the Biden Administration's COVID - 19
Transition Task Force. Learn more about her work by going to
@ justhumanproductions.org and follow her on Twitter
@CelineGounder . Dr. Gounder , we want to thank you for your
commitment to going w here the biggest problems in the world are ,
for tackling these great challenges and global health . For training the
next generation of healthcare providers, and for joining us today on
Conversations on Health Care.

Dr. Celine Gounder: Oh, it's my pleasure.

Dr. Celine Gounder - 20210329GounderXM

Margaret Flinter: Thank you .

Mark Masselli: Ciao .

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Mark Masselli: At Conversations on Health Care, we want our audience to be truly in
the know when it comes to the facts about health care reform and
policy. Lori Robertson is an award winning journ alist and Managing
Editor of FactCheck.org, a nonpartisan, nonprofit consumer advocate
for voters that aim to reduce the level of deception in U.S. politics.
Lori, what have you got for us this week?

Lori Robertson : President Joe Biden has made some mislea ding claims while boasting
about his administration's progress in getting Americans vaccinated
against COVID - 19 . In remarks he made in February at a Pfizer
manufacturing site , Biden claimed that the Trump administration had
“ failed to order enough vaccines . ” The Trump administration had
contracts in place for plenty of vaccines for all Americans, provided
other vaccines gained authorization. The President also claimed there
was, “ no real plan to vaccinate most of the country ” when he took
office . There was indeed a plan to acquire and distribute vaccines. The
Biden administration has done more on increasing vaccination sites
and vaccinators . As of December 31 , 2020, the Trump administration
had contracted to buy at least 800 million COVID - 19 vaccine doses
wi th delivery by July 31. Those doses included vaccines from fo u r
companies who had not yet received FDA authorization. There were
at least 1 billion doses under contract as of January 2021. The
government could acquire additional doses by exercising options to
do so under the agreements with vaccine companies.

So the Trump administration had clearly ordered enough vaccine
doses for the U.S. population. However, the issue is that only the
Pfizer BioNTech and M oderna vaccines had been authorized when
Biden mad e his remarks on February 19. About a week later, the FDA
authorized the Johnson & Johnson vaccine . In December, Pfizer and
M oderna had agreed to provide 400 million doses by the end of July
for the two - dose vaccines. The Biden administration announced in
February that the two companies would provide yet another 200
million doses by the end of July for a total of 600 million doses.

As for Biden's claim that there was no real plan to vaccinate most of
the country , his administration has built upon vaccinatio n plans made
by the previous administration. Dr. Anthony Fa uci , Director of the
National Institute of Allergy and Infectious Diseases, told CNN on
February 16th, that there had b een a vaccine distribution plan but a
“ rather vague plan on getting the vaccin e doses into people's arms. ”
The Biden administration has taken steps to increase the number of

Dr. Celine Gounder - 20210329GounderXM

people who can administer the vaccines and where the shots can be
given. These steps have also come as vaccine availability has
increased. And that’s fact check for this week. I'm Lori Robertson,
Managing Editor of FactCheck.org.

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Margaret Flinter: F act C heck.org is committed to factual accuracy from the country's
major political players and is a project of the Annenberg Public Policy
Center at the Universi ty of Pennsylvania. If you have a fact that you'd
like checked, e - mail us at www.chcradio.com . We'll have
FactCheck.org’s Lori Robertson check it out for you here on
Conversations on Health Care.

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Margaret Fl inter: Each week Conversations highlights a bright idea about how to make
wellness a part of our communities and everyday lives . Daniela Tudor
had a revelation a few years ago, waking up on the cold floor of a jail
cell, she could ask for help for her dru g and alcohol addiction or she
could die. She chose the former . Tu do r then launched not o nly on her
own recovery journey but on a broader quest to develop tools that
can help all people grappling with addiction recovery to avoid relapse,
which is so common , especially in the early days of sobriety, she
realized that there needed to be more readily accessible tools for
those in recovery to stay connected to their treatment goals beyond
the 12 - step meeting s and the talk therapy sessions.

Daniela Tudor : So WEc onnect help was created based on my own personal
experience, I am in long term recovery. And I went through a four -
week inpatient treatment program , where at the end of that four -
week program, all I received was a piece of paper that listed an
enormous amo unt of things I'm supposed to do on a daily and weekly
basis for the rest of my life to stay in recovery. And I knew that
building something on our cell phones that are with us, 24 /7 ,
regardless of where you're from and who you are, would be a way to
bridg e that gap and keep people accountable through an app to those
activities.

Margaret Flinter: So she founded WEconnect a relapse prevention on the go mobile
application that can be downloaded on a smartphone. The platform is
designed to keep people e ngaged in their recovery plan u sing daily
reminders and a reward system for when you perform the tasks that
are essential to recovery.

Daniela Tudor : So for me, some of the key things activities that keep me accountable
in my recovery are meditation, EMDR therapy , and community
support meetings. The individual along with the support of our

Dr. Celine Gounder - 20210329GounderXM

certified peer recovery support specialists are able to input those
activities into the app. And when it comes time for that activity to
start, you simply check into it. You see at the top of the app, how
you're earning your incentives. And either way, this incentive program
is based on evidence based research called contingency management.
So it's actually proven to show that it keeps people accountable to
their recovery plans o r their care plans. And in return, you get credit
for completing them. And you can earn incentives or rewards like
Amazon gift cards, which has been particularly amazing for
populations like Medicaid in a various amount of settings where they
can use those rewards and earn them and use them for things like
getting their kids gifts or food or household item . The way that we've
digitized it and the immediacy of that incentive, keeps people
accountable to checking into those activities on the go.

Margaret Fli nter: And the digital platform also allows everyone who's connected to the
person's health care ecosystem to see in real time activit ies that are
enhancing recovery a nd also when one might be at higher risk for
relapse.

Daniela Tudor: We have trained peer recovery support specialists all across the
country. And they get to leverage a tool that we developed called a
data dashboard, where they can see in an instance if someone needs
additional support or outreach and that is built through the app,
keeping the m accountable to those activities and the peer having
insights on how they're staying accountable to those activities in real
time. And again, the risk score shows like your engagement and your
care plan activities which are correlated to then if someone f alls off
track, and I don't complete those activities, I know that the risk
increases. And so that correlation is super important. And staying
abreast of that in real time can make a big difference in someone's
life. So it really allows for this connection of support 24, /7 and
visibility so that when someone needs that added support, you know,
not days or weeks go by which is witho ut this program is what
happens but rather gives insight and gives the option for connection
in real time .

Margaret Flinter: Sin ce the pandemic hit Tu d or says the WEconnect platform has been
a lifeline for those in recovery. Those now of ten cut off from meetings
and in - person sessions during the shutdown .

Daniela Tudor: Actually, when the pandemic hit. Immediately, my heart went ou t for
why none of us have support meetings to go to any more in person.
So we immediately stood up with a set of partners, these mutual aid
meetings that are online that are led by certified peers. And within
just a couple of months, over 200,000 people jo ined from all states
and several countries. I would say that your biggest strength is asking

Dr. Celine Gounder - 20210329GounderXM

for help. And that's not just in specifically with recovery. But
anywhere . Our business would not be as successful as it is today.
without us con stantly asking fo r partnership or support. When I don't
know something I ask about it. And I think that is strength. And I'm a
big fan of Rene Brown, for example. So I find vulnerability to be true
strength. But for anybody that feels stuck or feels like they're in a
place where they want change but they're afraid of it. Asking for
support is a huge sign of strength.

Margaret Flinter: WEconnect a downloadable app designed by people in recovery , for
people in recovery, to help maintain sobriety with a support system in
the p alm of their hand, keeping them on track with health goals,
staying connected to a care team and avoiding relapse. Now that's a
bright idea.

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Mark Masselli: You've been listening to Conversations on Health Care. I'm Mark
Masselli.

Margaret Flinter: And I'm Margaret Flinter.

Mark Masselli: Peace and Health.

Margaret Flinter: Conversations on Health Care is recorded at WESU at Wesleyan
University, streaming live at www.chcradio.com , iTunes, or wherever
you liste n to Podcasts. If you have comments, please e - mail us at
[email protected] , or find us on Facebook or Twitter. We love
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