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Brian Lehrer: Brian Lehrer Show on WNYC. Good morning, everyone. Today, on the show, we'll have our climate story of the week and it'll be about the unprecedented heat wave in Europe. 100 degrees is rare enough in most places. In the UK, it's unheard of, so there isn't much air conditioning, but it was 102 degrees over there, at least in one city over there, I looked at online, a little while ago, 102 at last check.

Paris also has 100 right now. What's the effect on people? What does climate change have to do with it? What do humans have to do about it? On our climate story of the week coming up.

Also today, a new plan and new questions about a new Penn station. Everybody wants one, but how to design and pay for it gets contentious for people who live near there, for taxpayers, and for commuters. We will look at the new agreement between Mayor Adams and Governor Hochul, and some of the objections. We'll have the chief medical officer of Planned Parenthood of Greater New York on the influx of patients from newly restrictive states. It's happening. How are they meeting the demand? How can you help and how is it affecting access for people who live here?

We begin on the medical track today. Back with us now is the New York City Health Commissioner, Dr. Ashwin Vasan to answer your questions and mine. Among our topics today, we'll talk about the latest developments on monkeypox, the newest COVID surge, including confusion many people seem to have about how long you need to isolate yourself if you keep testing positive more than five days after you got sick. That seems to be happening with this particular variant.

We'll touch on reproductive care access with him too, and how people can be helped by the new National Mental Health hotline 988. Mental Health now has its own emergency number, as you probably heard, separate from the jumble of things that go to 911. Dr. Vasan, commissioner, always good of you to come on. Welcome back to WNYC.

Dr. Ashwin Vasan: Hi, Brian. Great to be back.

Brian Lehrer: Let's start with the Mental Health hotline 988. Mental Health was your specialty at Fountain House before you joined city government, and 988 opened its lines on Saturday. I've seen some news organizations call it a Mental Health hotline, like I just did. Some others call it a suicide hotline. Is this primarily for people having immediate suicidal thoughts?

Dr. Ashwin Vasan: Thanks, Brian. Yes, it is certainly amongst its goals is to address the needs of people who are having suicidal thoughts and ideations, but it is also supposed to get people the immediate support that they need and counseling and have someone to talk to, whatever mental health issue they're facing and to be able to then connect them into local resources.

Now, number one, I think 988 is a watershed moment. It's really the first comprehensive federal mental health legislation we've had in a very long time to support new mental health infrastructure.

That said, it's going to take a lot more work and investment and standardization in order to build out systems that actually function as intended. The beginnings of it are good, but there's a lot more work to be done. Yesterday, here in New York City, we announced additional almost $11 million of support to expand our existing Mental Health hotline NYC Well, to lay the foundation for the expansion coming in from 988 and to ensure that New Yorkers, regardless of which number they call, get access to the same suite of services that have been offered since 2016 by NYC Well.

We hope to be a leader in 988 implementation, eventually unifying towards a single number, but really what's most important is what's behind that number. What are the services people get access to?

Brian Lehrer: What can you say about the demand or the number of calls going to 988 from people in the city in these first three days, if you have any numbers, and if you have any data on what the most common needs that people are expressing have been so far?

Dr. Ashwin Vasan: It's a little too early to tell. The fact that the call line went up on a Saturday, obviously, any delays in data collection come from that as well, but as soon as we've got data to call aid and analyze, we'll share with the public, we'll do that. In general, with NYC Well, we see a whole range of needs. We see from basic questions like, "I want to get access to a therapist or a mental health provider," and we can help people access that.

"I want someone to talk to immediately. I'm not feeling well. I'm feeling depressed. I'm feeling anxious. I'm feeling suicidal." We have people who can do that. Or, "I'm in need of real immediate help," and through NYC Well, we can deploy mobile crisis teams.

Lastly, of course, if there's a real emergency, if there's any sort of threat or potential of violence, self-inflicted or otherwise, we can always get emergency response, including our B-HEARD program that would be diverted through the 911 system currently. There's a lot of options when someone calls NYC Well, and we'll be collecting more and more data on how the 988 calls differ in any way, if they do, or how similar they are to the existing calls we get through NYC Well.

Brian Lehrer: Some people on our social media feeds are worried it will still lead to dangerous contact with the police. If people call 988 or NYC Well and report themselves as being in some kind of mental health crisis, what can you tell them to reassure them or not?

Dr. Ashwin Vasan: The overarching goal of having an entirely separate national call line that is the same three-digit number starting with a nine, but different to 911, is so that more and more calls about people with mental health needs go directly to this number and that we don't necessarily expect 911 dispatchers to have the expertise to be doing the decision making about risk and all of these other things, which is a very difficult thing to do in the moment.

It's also why New York City and places all around the country have invested in non-police alternatives to mental health emergencies. We have the B-HEARD program here in New York City, but that's based off of years of experience from places like Eugene, Oregon, Denver, Colorado, San Antonio, Texas. There's places all around the country that are using non-police responses to mental health emergencies, and that needs to become the standard of care, and 988 is a big step forward into making it so. It's going to take some time.

Brian Lehrer: WNYC reported over the weekend that the federal government provided a huge sum, $400 million, to help local governments build out the 988 call centers and that places like New York and New Jersey also added millions of dollars through their budgets, but other states haven't added this backing, which means their residents calls could be rerouted here. Do you see that happening yet?

Dr. Ashwin Vasan: A little too early to tell on that very specific question, but I think you raise a larger point. $400 million is a start, it's nowhere near enough to build out these systems across the country. As you said, it's a very patchwork implementation. Some jurisdictions have taken that money, used it well. Some have not. Some, like ours, have supplemented that money with our own state resources and local resources.

One thing we need in this system is standardization. That's why we support the bill S. 1902, which calls for a set of national standards for 988 implementation across the country so that we can have some consistency and so that people who call 988 from their local jurisdiction can expect to get resources in their local jurisdiction, rather than rerouted to a national call center or having issues with geolocation as you're describing, which could end up routing them to another jurisdiction altogether.

That is certainly stuff that's going to require much more federal support. I think the initial dollars that the government outlaid is welcomed, but we need much more.

Brian Lehrer: Which also means that states with less of a commitment to public health are sponging off the taxpayers of New York, or wouldn't you put it that way?

Dr. Ashwin Vasan: Hey, I don't know if it's that clear just yet, and I don't know that we know enough because we're only three days into this, about how this geolocation or lack of geolocation is actually going to play out, but it's certainly a risk that, if you have neighboring states or states in similar regions, that some who choose to be leaders in this and some who don't, that if geolocation is not solved, that you could end up with that disparity.

The one point of optimism here is that this seems to be actually a bipartisan issue. I know that word bipartisan doesn't really exist anymore, but this mental health and this call line actually seems to have pretty wide support across the aisle. We're hopeful that we'll actually see relatively consistent implementation across "red and blue states."

Brian Lehrer: Yes, I think for some Republicans this is the alternative to gun control laws, but I won't make you comment on that.  Listeners, your calls for the New York city health commissioner, Dr. Ashwin Vasan on 988, Omicron BA.5, abortion access and capacity, monkeypox or anything else relevant to him? 212-433-WNYC, 212-433-9692. Ask Dr. Vasan your public health question. 212-433-9692 or you can tweet your question @BrianLehrer.

Dr. Vasan, on another topic relating to services here for people from out of state, New York is committed to being a safe haven, as you know, for anyone seeking an abortion from a newly restrictive state after so many suddenly flipped to that status after the Supreme Court reversed Roe v. Wade last month. Is this under your wing as health commissioner at all? Is the health department expanding capacity to help people coming in from elsewhere?

Dr. Ashwin Vasan: Yes, as we announced on the day the Roe decision came down, that very difficult day, while the state and the governor announced direct support to abortion providers, which we were extremely thankful for, similarly, we stated some priorities for the city, both here at the health department as well as across city government to make access to abortion care easier, more widespread and to reduce barriers, especially for people coming from out of state.

That means not just access to procedures, like expanding medication, abortion access at our sexual health clinics and other clinics, expanding access to abortion care and training providers at our health and hospital system here in the city. It also means all of the ancillary support that people need. If they travel long distances, come into our state, they need pre-care, post-care. They need monitoring, they need lodging, food. Often, these are women and people in dire circumstances that need a lot of support, let alone mental health support.

This can be a very traumatic event and a very stressful one for the person. We're looking at ways to invest in all of those things and we're creating an abortion navigation hub and hotline where people can call and access New York city based resources. In the coming weeks and months, we'll be making more announcements about when those things will go online.

Brian Lehrer: Are you seeing an instant increase in that demand from people coming into the city from out of state just since the court ruled about three weeks ago? Can you quantify that at all?

Dr. Ashwin Vasan: Yes, I can't really quantify it, but I'm certainly hearing. We've abortion providers around the city including Planned Parenthood. I visited it with the mayor just a couple of weeks ago and they immediately saw an uptick in people coming from out of state. Really tragic stories of young people of really horrible cases that now are denied access to life-saving care and much-needed medical care in their home states and they're seeking refuge here in New York.

I would be hard pressed to say there hasn't been an uptick because that's what we're certainly hearing anecdotally. I think, over the next weeks, we'll know more through the data.

Brian Lehrer: Listeners, we're going to talk to the chief medical officer from Planned Parenthood of New York City or of Greater New York more about that particular topic later in the show. Let's take a first phone call. Here's Suzanne in Merrick on the 988 mental health hotline. Suzanne, you're on WNYC. Hello?

Suzanne: Hello. Can you hear me okay?

Brian Lehrer: We got you fine.

Suzanne: Thank you. My question was this about the 988 hotline. There's $400 million put into this and more, but the problem that I can see is that there are not adequate mental health services out there to refer the people to. For instance, I have an example that's personal to me, adults with autism or adults with developmental disabilities who have comorbidity. They have also mental health issues that can be a danger to them themselves and to the community possibly.

For instance, in Kings county, there are only six beds at Kings County Hospital to treat adults with developmental disabilities who have mental health issues. That's just one example. I don't know how many other examples must be out there. A lot of them aren't even-- My question to the gentleman is what about funding mental health services themselves rather than referrals to mental health services?

Brian Lehrer: Thank you, Suzanne. Dr. Vasan.

Dr. Ashwin Vasan: Yes, I think this is a really incredible point. You're making, Suzanne, because 988 is not a panacea. It's not a solution to decades of real neglect of our mental health system nationwide. We have not had any real federal omnibus spending to improve our community mental health system in decades. In fact, the first infusion of new capital we've seen into our community mental health system was seen as a part of the massive COVID relief packages we saw starting in spring of 2020.

We have a lot of work to do to build up our community mental health systems. The caller is raising a really important issue about access to care not only for specific mental health disorders, but also intellectual and other developmental disabilities. These are all related, but not the same. We need to certainly expand funding for community-based care, decrease our reliance on institutional care and hospitalization, which is expensive, costly, and not always high-quality.

988 is simply a gateway to the system we have. To ensure that gateway, that health issues, especially health emergencies are met with a health response, a care response, but caller's absolutely right, we have a lot of work to do to actually build up our system. It's an all-hands-on-deck effort.

Brian Lehrer: In fact, to one of the points that you were suggesting there and that the caller did, I read an article yesterday that was about how people act suicide prevention hotlines in the past, maybe the broader mental health hotlines that are now being developed with 988 and other things, aren't well trained to deal with people on the autism spectrum, which the article said is about 2% of the population, and yet people aren't trained to communicate effectively with them or deal with particular problems they tend to present with and that they do present with mental health issues at a greater rate than the general population.

Is this something you're familiar with or train people for specifically in the city?

Dr. Ashwin Vasan: Yes. We're certainly familiar with the needs, care for people with autism spectrum disorder and other disabilities and special needs is incredibly scarce all across this city and country. Frankly, our knowledge of how to support people, especially adults, but even children with autism has grown exponentially just in the last 10 years. What we need is investment to match up with that knowledge.

Again, I think that's really a nationwide issue, a nationwide crisis. I think people will say, well, what can you solve here in the city? I think it's really important for folks to understand that the routes of paying for our mental health care really start with the way that we reimburse for it in our overall policy through reimbursable insurance programs, whether that's commercial insurance or Medicare and Medicaid.

That is to say that we do not pay equally for mental and behavioral health conditions as we do for physical health conditions. That's been since the beginning of time and since the beginning of the insurance industry, we've had those disparities. The issue I'm referring to is mental health parity. We have very strong parity laws on the books, federal laws on the books, but they're not consistently enforced.

We see a consistent disparity in the way that mental healthcare is paid for. That drains billions of dollars out of our mental healthcare systems that could be plowed back into expanding access to care, hiring providers, and meeting the needs of special populations like the ones you're describing, whether it's autism, people with intellectual and developmental disabilities.

We need some deep and structural reform in our mental health payment system in order for actual access to care to change and quality of care to change

Brian Lehrer: Journalist of credit where it's due, I read that article on the website of WUSF, which is the public radio station in Tampa. We'll continue in a minute with the New York city health commissioner, Dr. Ashwin Vasan, we've been talking mostly about the new 988 mental health hotline. We'll go to some of the vexing questions about the Omicron  BA.5 variant now spreading so quickly in the city and elsewhere and other things, and more of your calls. Stay with us.

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Brian Lehrer on WNYC with the New York City Health Commissioner Dr. Ashwin Vasan. I'm going to go right to Debbie in Brooklyn to launch the Omicron BA.5 portion of our conversation with a question that's similar to one that I raised in the intro that I've been hearing from a number of people I know. Debbie in Brooklyn, you're on WNYC. Hi there.

Debbie: Hi, Brian. Thank you for taking my call. I was exposed to COVID, and symptomatic, but have tested negative on a PCR. Don't know what to do.

Brian Lehrer: Oh, so you did not have a positive test at all, but you feel like you have symptoms that are consistent with COVID, is that it?

Debbie: I've had all the symptoms. Lost taste, lost smell, fever.

Brian Lehrer: Dr Vasan Debbie wants to know when she can leave her house.

Dr. Ashwin Vasan: Yes. Thanks, Debbie, I appreciate the question. Look, the challenging thing about COVID is that, especially now, the symptoms look very much like other viruses, so it could very well be that you have another seasonal virus. Especially if you've tested with the PCR test that's been negative. What we recommend is, if you're testing with a rapid test at home, antigen test, and you test negative, but you have symptoms, go get a confirmatory PCR test just to make sure.

If you've done that and you keep testing negative, there is a likelihood you might have another pathogen which doesn't have as strict isolation guidance as COVID. If you're not feeling well, and I'm sorry you're not feeling well, get some rest and stay home, but as far as strict isolation guidance when you don't test positive for COVID at all, we don't have any.

Brian Lehrer: Debbie, good luck. I hope that's helpful. That's related to, but not the same as the isolation question that I was going to ask, so I'll ask you that now, because people with BA.5 seem to test positive in some cases long after they're feeling better. I know two people right now who are around day 9 and they're still staying isolated even from their own COVID-negative kids.

Luckily, they both have spouses who can accommodate that, but they're increasingly frustrated seeing that positive line in their tests every day. I know other people are in that situation too. What's the guideline, and what do you consider safe from a contagion standpoint?

Dr. Ashwin Vasan: It's a vexing problem, and it's something that we have heard. Right now, we are still sticking with the guidance of staying home for five days and isolating from others in your home, as well as others from outside of your home, of course. Wear a well-fitting mask if you must be around others in your home, and don't travel, of course. To end isolation, we would say you end isolation if you are fever-free and symptom-free for 24 hours.

We also recommend that you retest and you test negative. If you do not have any symptoms after five days, we still recommend that you wear a mask for the full 10-day period even if you choose to leave your home.

Now, if you test positive and you're asymptomatic, that's where this is becoming a little bit tricky, because it sounds like your friends might be asymptomatic. If your friends are symptomatic, the answer's clear, stay home. If you have any symptoms, don't be around other people, and continue to isolate from your family. I think that the situation you're describing is that your friends have no symptoms, but keep testing positive.

That's a tricky situation. It isn't incredibly likely that they are truly positive without any symptoms, even though, obviously, COVID has very clear asymptomatic spread, but moving from symptomatic to asymptomatic we haven't really described that.

We would say keep testing yourself, go get a confirmatory PCR as well to make sure that these are true results, and definitely, if you do go out in public after the 10-day period, wear a well-fitting mask.

Brian Lehrer: Joe in Manhattan you're on WNYC. Hi, Joe.

Joe: A couple of questions since everybody and his brother now has COVID. Why, when the spread is high in New York City, has the Adams administration changed nothing? That's question one. Question two is can't there be developed something where people who test positive at home can report it so we have more accurate data on how many people actually have COVID?

Brian Lehrer: Thank you, Joe. Take on both of those questions, Dr. Vasan. They're both important.

Dr. Ashwin Vasan: Sure, absolutely. I'll start with the second question. I think New Yorkers have gotten used to reporting as many tests as possible online, but I want to be really reassuring and clear to people, we have never captured every COVID positive case in this city, and we have more than enough clinical testing still ongoing to do surveillance.

The way that I usually talk about is like raindrops. When we assess rainfall in the city, you don't need to collect every raindrop, and we do not need to record every test. That's why we're moving to and have moved to an intentional strategy of more at-home testing. We don't have to record those in order to get a good sense of surveillance of the pandemic.

Brian Lehrer: Well, let me follow up and ask on that specific point. How do you even estimate the number of at-home tests positives? How do you even have any idea what to extrapolate from if you don't know how many people are testing at home?

Dr. Ashwin Vasan: Well, what I'm saying, Brian, is that we're still doing enough recorded brick and mortar testing that's getting into our clinical surveillance system for us to get a good picture of it. What I was going to say was that the moment that that volume of testing falls below a certain threshold, we also have wastewater testing we can kick to if we see that that's a more sensitive and early warning system for case increases.

Thus far, our wastewater testing and our clinical testing have been right in line with one another which is why we don't report routinely on wastewater, but if we see a dramatic decline in testing, to the extent that it no longer gives us that surveillance capability, then, of course, we'll switch it.

The point of at-home tests is not to record them, the point of at-home tests is to let individuals make safe and healthy decisions and to protect themselves and those around them, and to empower people to get tested frequently and often before they choose to expose themselves to others. That's really the strategy here, but we are doing enough tests now to get overall population estimates and surveillance.

Brian Lehrer: To her question about the Adams administration not changing any rules or requirements in the face of the current surge, let me ask you a specific question about that. Your official guidance now, if I'm not mistaken, is to encourage people to wear masks in indoor public settings during the surge, but the mayor, again as I understand it,won't require it for his own employees to protect their health and that of the public who come into city offices for city services like some private businesses still do.

Shouldn't the city have a masking policy for indoor public spaces during the BA.5 surge?

Dr. Ashwin Vasan: Look, one thing I want to start with is that we are at a different time in this pandemic. A case of COVID in July 2022 is not the same as a case of COVID and its impact in January 2022, and certainly not from March 2020 and earlier waves. We're seeing that play out in the severity of hospitalizations, the ICU admissions, the number of hospitalizations due to COVID versus the hospitalizations incidentally found to have COVID.

Those are all numbers that are shifting in the right directions. It behooves us to take a step back and reassess where we are in terms of how we establish levels of risk, set policy around those levels of risk, and of course, communicate to the public.

That's explains why now we are still in a level of high community transmission of COVID, and it's why our recommendations to New Yorkers are to wear a mask indoors, to get tested frequently, especially with at-home tests, but wherever you can get tested. To get treated if you test positive. We have widespread access to treatment, more than really any other city in the country. Of course, if you haven't been vaccinated and boosted, to do that now. There's never been a better time. As far as setting population-wide policy, I think we need to use that tool judiciously. When we see that there are really emergent issues in terms of its impact on overall  human health and lives.

Now I want to be life and death. What I want to be clear though about is that this has never been and continues to not be experienced equitably. That's part of why we're stepping back and looking through the equity data looking through the hospitalization data looking through the transmission data and saying what's the best way to communicate risk.

I know this is an ongoing conversation nationally as well. I think what I would say to the caller and what I'd say to all New Yorkers is take those smart and responsible steps that we're strongly recommending, mask up indoors.

As far as bringing back population-wide mandates, we want to use those tools judiciously and sensibly when they're needed to really prevent the worst outcomes.

Brian Lehrer: Requiring the masks that you're encouraging in city office buildings where people from all strata of the public come for city services is not what you consider judicious or required?

Dr. Ashwin Vasan: Look, we're always looking at where and when best to do this. We require masks in public hospitals and in healthcare settings and in nursing homes and in congregate care settings. We have outlined in jails and prisons.

We have outlined what high-risk settings look like, this isn't a blanket issue but we are actively exploring when and where the best time to bring back those population-level mandates are and requirements including for masking. We'll be very glad to talk about that more in the future.

Brian Lehrer: One follow-up about personal steps that people can take. If this is the most transmissible variant yet, where are the increases in where people are bringing it into their homes from-- I have one friend who was at a superspreader wedding recently, another one who may have gotten it at another wedding but not everybody's going to indoor weddings.

Is it back to the office in person work? Is it restaurants and gyms and hair care places? Is it public transportation more than we like to admit with masks coming off more despite the rules? What places are people getting it to bring home?

When we say most transmissible variant yet, does that mean something in terms of the length of exposure before you're likely to get sick? I think there was an old guideline of like 10 or 15 minutes in the presence of an infected person, below that,you're fairly safe. Is there a new number and where are people picking it up from each other?

Dr. Ashwin Vasan: These are all really good questions, Brian. I think we learned early on, with COVID, from even original the original variant or the original sequence, that this virus moves too fast for us to do meaningful contact tracing for us to really break chains of transmission in the ways that we would traditionally do.

That's a very tough question to answer. I think part of the reason why at the time of real emergency and fear, we needed to bring in those population-wide mandates to keep everyone safe because COVID was moving so fast. As it's moved faster as it's become more transmissible, our knowledge of where it's more transmissible hasn't really changed because it's moving too fast for us to keep up with its transmission in a geolocation level now.

We are looking at a neighborhood level. We are looking at a zip code level and trying to analyze that data, which communities are most impacted both in terms of cases and hospitalizations? Of course, deaths, we continue to look at that data. That's part of why I bring up the issue of equity in our strategy is because it's not as simple to say "Well, we're done with this and we don't want to bring back any of these rules."

That's not what this administration is saying. What this administration is saying is that we're going to use these judiciously and we're going to do it in ways that really try to protect equity. We also have to just acknowledge we're in a different time today in July 2022 than we've ever been in this pandemic. It's not the same as it was.

Brian Lehrer: One more before you have to go. Jen in Manhattan, you're on WNYC with health commissioner Dr. Ashwin Vasan. Hi, Jen.

Jane: Hi, Brian. I'm so excited to speak with you. I'm such a fan and you are an absolute gift to journalism.

Brian Lehrer: You're too kind. What's your question for Dr. Vasan, because we're running out of time?

Jane: I just miss you so much after seeing you at the green space. I just wanted to know, with our very slow response that we've had to COVID over the years and the COVID vaccine, with monkeypox on the rise, when will the vaccine be available to all of us who actually want to get the vaccine?

Brian Lehrer: Dr. Vasan?

Dr. Ashwin Vasan: Thanks. Great question. We are wholly dependent on the federal government for vaccine supply. I do want to be clear that this is not the same as COVID in the sense of everyone needs to get vaccinated. Right now it's really people in at-risk groups who we think are at high risk of number one getting monkeypox transmitting monkeypox, number two, or having a severe outcome if they do get monkeypox.

That's by virtue, number one, of the fact that vaccine supply is limited but it's also a by-virtue of what the data is showing us that right now cases are confined mostly to gay men, men who have sex with men and the trans community. We're trying to really focus on targeted efforts to meet the really vital health and human rights needs of this population by getting them access to vaccine first and as widely as possible.

We're working closely with our federal partners to make that so. We certainly need more vaccine than we've gotten. New York is the epicenter of this outbreak in the United States. We have more than 30% of the cases in the country. We need to start seeing more vaccine come in so we can get it out to New Yorkers as quickly as possible

Brian Lehrer: Just a quick follow up. I know we're two minutes over time, but a listener tweets "What's being done for people incarcerated in New York on this? Are there monkeypox vaccines at Rikers?"

Dr. Ashwin Vasan: Right now we're following the epidemiology, we're following the case counts. We currently haven't seen reports of cases inside those settings, but we are obviously prepared to deploy vaccine and to get folks access to vaccine everywhere and anywhere in line with the amount of vaccine that we have. We're following the epidemiology on that.

Brian Lehrer: Dr. Ashwin Vasan, the New York City health commissioner. We always appreciate you coming on and answering people's questions. Thanks a lot for today.

Dr. Ashwin Vasan: Of course. Thanks so much, Brian.

 

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