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Brian: It's The Brian Lehrer Show on WNYC. Good morning everyone. Here's a simple and probably the most important indicator of what's happening with the coronavirus pandemic in the United States. For the week ending Saturday, November 15th or 14th I should say, there was an average of 1,148 coronavirus deaths every day. According to The New York Times virus tracker, an average of 1,148 deaths a day.

By comparison, for the week ending October 15, an average of 701 people died every day in this country. In the last month, we've gone from 700 deaths a day from the virus to more than 1,100 deaths a day from it, as the virus is spreading more quickly, and that small but consistent percentage of people succumb. In New York State, 196 people died from the virus last week. 140 people in New Jersey. That's up from around 50 people a week in New York and around 35 in New Jersey, or let's say an extra 35 deaths approximately every day in our region compared to mid-August.

At the same time, there's economic devastation from closing ourselves off from the virus. The Times reports today, for example, on the extreme contraction of tourism in New York City, down from a $66 billion industry last year to only around a third of that much projected for this year.

It says before the shutdown in March, the hospitality industry provided as many as 400,000 jobs in the city. Seven months later, at the end of October, more than 1.3 million residents were collecting unemployment benefits. The city's unemployment rate is 14% more than double the national rate. We also know that murders are up and traffic deaths are up since the pandemic began. Not nearly as many deaths as from the virus, but still up and other secondary ills as well.

We'll talk later in the show about how lead screenings for children in New York City are down during the pandemic. What do we do about it? What's the balance between saving lives and saving livelihoods? We know we're being urged not to gather in groups outside our usual pods for the holidays. If you do, do it with thorough testing protocols for just before you gather and quarantining afterward.

We know the encouraging vaccine news won't help us this winter. We know about the raging debate in New York, New Jersey, and elsewhere over whether go to or remote schooling. You know about the debate over whether ending indoor service at bars and restaurants at 10:00 PM goes far enough. Some places are going much further. Oregon, for example, with its new spike is back to takeout only at restaurants, not even outdoor dining anymore.

Gyms and museums are closed there again. Even outdoor cultural activities. Outdoors, like zoos and public gardens, they remain open here. The limit on at-home gatherings in Oregon is six people at a time and coming from no more than two households. Here it's 10. Visits to nursing homes are once again banned out there, but notably, schools remain open, so do barbershops and other hair salons because that state has not seen a link to cases when masks are being worn in those facilities. Interesting.

That's statewide in Oregon, where the positivity rate is 13% compared to about 3% statewide in New York. In some places though, the local rate is higher around here. The city of Mount Vernon in Westchester has imposed the stay-at-home advisory except for work, school, and essential services, but restaurants, gyms, and everything else remains open in Mount Vernon. What does it mean? What did we learn from the first wave of stay-at-home orders in the spring to make them more subtle and hopefully more effective today?

With me now is Dr. James Hamblin MD, a staff writer for The Atlantic and host of their pandemic-related podcast called Social Distance. His latest article is called How We Survive the Winter. The coming months of the pandemic could be catastrophic. The US has ways to prepare. Dr. Hamblin, good to have you on again. Welcome back to WNYC. Do we have Dr. James Hamblin? Do we have me? Yes, we have me.

Juliana in the control room confirms that we have me. Hello, everybody, you still have me. Any second now we will have Dr. James Hamblin back. What I'll do while we're reconnecting the line, I'm sure this will just take a second, is just open up the phones and invite your questions on the ideas that I just set up.

Wherever you are in Greater New York or in America, what's the state of the openings and closings in your area? What do you think they should be? 646-435-7280, 646-435-7280. Now, I think we have Dr. Hamblin. Dr. Hamblin, are you there?

Dr. James: Hi, I am. Thank you for having me.

Brian: Good. Welcome back to WNYC. One of the sources in your article says businesses and local governments and other institutions should have clear triggers for different levels of shutdowns. Do you see that around you as much as you would like? It seems to me as I was laying out in the intro, that different places have different triggers.

Dr. James: Right. I think that is part of the plan that even city to city and region to region, there might be different thresholds for exactly when things can be open or should shut down. There's a lot of everyone's learning on the fly here. It depends on how well people do as individuals in terms of their own behaviors, all kinds of things about the density of populations.

There's just so many variables that it's reasonable to expect that different regions, different cities would handle things differently and that there would be heated debate about what those thresholds should be as we're hearing now in New York, with regard to the school closure threshold.

Brian: Can I ask what you think of the Oregon model, for example, with no indoor dining, or museums and almost no office work and just six people in your homes, but hair salons, as well as schools, are open? That's a very different mix from in New York, for example.

Dr. James: I understand the economic impacts of closing bars and restaurants, hair salons. I don't take any closures lightly, but I think there is gaining consensus that schools need to be a priority. I think that seems to make sense. If there is convincing evidence, at least in that region, that specific sectors, specific behaviors are just simply not driving transmission and can be done really safely, as may apparently be the case with hair salons, then you have these exceptions which might seem to break a rule because it's a small establishment that seems not exactly essential.

If we've found over the course of a few months that it can be done safely without transmission, then that's great. It might seem a little counterintuitive to have hair salons open when you don't have more essential things open. Again, I haven't seen their data, but assuming that they really believe it can be done safely, then that's great. That's the goal of hopefully, we have enough evidence, and we have people who are really meticulously analyzing that evidence so that we can keep as many things open as possible and just target what are the highest risk activities.

Brian: Do you have an opinion about the schools? Listeners, I don't want to turn this into another call in about schools open or closed, as we've been doing for days on the show in a row. Schools and indoor dining which seemed to be opposed to each other, juxtaposed against each other in New York in the debate recently. It seems to me, Dr. Hamblin, that this has really flipped with respect to the schools since the summer.

That in the summer, when New York City was planning to open schools, at least as an option for parents, there was all this push, saying, "No, don't open the schools. What do you mean? Look, LA is going all remote. Boston is going to phase in only very gradually." Now, when they're going to close the schools, it's all, "What do you mean you're going to close the schools? It's such a lifeline for the children and there are hardly any cases."

I'm just curious how you see the evolution of thinking on that score.

Dr. James: I completely understand the many sides of this. I know that there will be justifiable anger, and fear, and outrage no matter what decision is made. I've said since the beginning of this pandemic, that the closure of schools was probably the most difficult question. I'd rather not take a side on that. I think that these things, it's kind of tragic that we're facing these problems as though we can't simply close businesses and bail them out for just the winter to get them through until we have a vaccine.

Unfortunately, we're operating in this world without another relief package. That is really what's forcing us into these debates where there's no clear right answer. Everything we choose is going to have significant costs.

Brian: That's a difference that's worth pointing out between here and in Europe. Europe has more anti-lockdown activism than they did in the spring. I don't know if they caught something from Michigan or from Trump or whatever it is, but there's more anti-lockdown activism there with their second wave and their second wave of lockdown than there was in the spring. There's still, in general, a pretty large public consensus that they're doing what they have to do over there, and they do in the case of Europe, have harsher lockdowns than in the United States. That's happening again now, as it happened in the spring.

From what I read, they're having luck, success, again, with those lockdowns, in flattening the curve from what they were experiencing a few weeks ago. One of the differences is what you were just getting at, they have more generous benefits, while we debate it every two weeks, what kind of benefits should we have for the next three weeks and the next six weeks. It's more of a given over the that people are going to be financially supported by the federal governments. That probably affects the politics of the two, you think?

Dr. James: Absolutely. It would be difficult, no matter what, but if people have some sort of lifeline, where they know their business is not going to go under, they're not going to lose their home, they're not going to be unable to feed their family. Any debate, then suddenly, really de-escalates. Whereas when you have people who are facing those kinds of choices, things get really heated, as we're seeing right here. We're forced into these false debates between, do we want businesses to go out of business, or children to be out of school, or people to die?

There's no good answer there. Unfortunately, we have this clear answer in the form of economic stimulus which we just really need to get us out of this debate.

Brian: Of course, they're stuck in polarized Washington and in the election season on that, and the polarized media in this country that debates lockdown versus liberation. It's not that simple. There's so much of an area in the middle to try to do this surgically, to try to do this artfully, to try to do this in specific ways that hurt people the least economically as possible, and hurt public health as little as possible. It does become an art, Dr. Hamblin, and it does become different in different places.

I mentioned the city of Mount Vernon here in Westchester with its stay-at-home advisory that was issued over the weekend. Except for work, school, medical and essential services, they say, but restaurants are open, gyms are open, it seems like everything else remains open. Is it clear to you, and I don't mean to single out Mount Vernon, similar things are true in a lot of places, but is it clear to you what stay-at-home advisory means in that case?

Dr. James: It seems to mean different things to different communities. That's partly by design, our public health systems are meant to be tailored to the needs of certain populations. You wouldn't expect it to have one single meaning in places that are experiencing just really horrific surges right now, like El Paso, you might expect that a stay-at-home order is truly-- the hospitals are full. There are makeshift morgues right around the corner that you don't want to end up in.

We need everyone really not to leave their home, versus the more casual order that you might hear elsewhere where cases are starting to rise. We really would strongly discourage things without the same level of urgency.

Brian: My guest is Dr. James Hamblin and the staff writer for The Atlantic and host of their pandemic related podcast called Social Distance. His latest article is called How We Survive The Winter. The coming months of the pandemic could be catastrophic. The US has ways to prepare. I see Dr. Hamblin tweeted out as he was coming on, "I will be on WNYC with Brian Lehrer this half-hour. Please call in if you have easy questions [laughs].

Your easy or other questions for Dr. Hamblin at 646-435-7280, 646-435-7280, as we talk about the many shades of openings and closings around the country right now, and how do we even understand them and how do we get them right? Sabrina is calling from LA. Sabrina, you're on WNYC. Hello from the Red Coast.

Sabrina: Hello, longtime listener, first-time caller. I just wanted to call in as you were talking today. I just arrived some days ago from New York after four months being in the city, being in Long Island, being Upstate. LA, you're not in Kansas anymore, for sure. You see a lot of people congregating. Gavin Newsom apparently went to the French Laundry for a dinner party. You just wonder as it was shown today that they're going to pull back the brakes. You really see that it's state to state, there's different mentalities and it's terrifying.

Brian: For people who don't know the reference you were just making, Gavin Newsom, of course, Governor of California, he's getting ripped for saying that he's putting on the emergency brake, he used that phrase, to order a lot more closures and a lot more staying at home in California because of the spike there, but at the same time, he was caught eating at a restaurant called the French Laundry, with a dozen people, and he's trying to get people to not congregate in groups that big.

There's a hypocrisy issue. I know that you can find that story on Fox News about every 15 minutes. What you found when you went to LA after four months in New York, Sabrina, is it that people just were more lackadaisical about wearing masks and congregating and stuff?

Sabrina: Yes. I think also, even friends of mine, I was getting used to wearing a mask all the time in the elevators, in the hallways, without thinking about it. Here, they actually made fun of me a little bit. You really realize that this country is very broad, and everybody is thinking differently.

Brian: It sounds like it's not Trumpy lack of mask-wearing, it's something else in the case of the people you were coming in contact with in LA.

Sabrina: Absolutely. A few of them were saying, "Well, it's only in the Midwest. We don't have to worry."

Brian: Sabrina, thank you very much. Dr. Hamblin, I don't know if you've looked at the California situation or regional cultural differences around mask-wearing and other things to have a take on that.

Dr. James: Yes. It seems to have a lot to do with not just politics, but the experience of a place in the memory of having endured a serious surge and having had family and friends and colleagues get sick, maybe even die. Having had to go through that, I think in New York, you see this memory of having lost 30,000 people in the spring and that sets new standards for the social norms where, not everyone, but most people are pretty good about wearing masks and you stand out if you don't.

Then there's unspoken enforcement which is really an ideal situation. Quite to the contrary, if you've been in a place that has not been hit hard yet, fortunately, then it's, I think, pretty easy for the cultural language to say that, I guess this isn't as big a deal as we thought and there's people all around me not wearing masks so I'll take mine off too. These things accrue and then when you suddenly move from one place to another, you go to a different state to a different city, you're shocked by how different those standards are.

Brian: What do you think about the science of masks? One of the things on the political right is to poo-poo mask-wearing and to not like how it restricts our being able to express ourselves and see each other's faces and things like that and to say over and over again, that the science is inconclusive at best and weak at worst on mask-wearing. How much have you looked at the data?

Dr. James: I haven't heard any serious scientists, any scientist that I've spoken to in my months of reporting on this pandemic, question the value of masks at all. They're one of the very few things that we can do to empower ourselves and to allow ourselves to reopen. There seems to be a set of people who want to have it all, to reopen, to congregate, to not wear masks, to not get sick, to have everything be normal and that really just doesn't make sense.

It would make sense to me if there were people who thought masks don't really work, we just need to shut down. Then there was a separate set that thought, "Well, we can really reopen if everyone's really vigilant about the masks." There's no question [crosstalk]

Brian: You can do all of it. The CDC just recently updated its findings to say masks protect the wearer, not just the people who we breathe on. That's an update to its original position on masks.

Dr. James: Yes. They certainly do, especially, N95. Healthcare workers wear N95 to protect themselves primarily. Other types of masks seem to be more effective in terms of limiting the output of the wear, but they certainly can't hurt in terms of blocking potential exposures. Given the vaccine news that we've been hearing in the last two weeks, these masks are not going to be with us forever. It's just something we have to deal with for the time being and they're a sign of solidarity and of compassion and of just everyone doing their part and trying to keep things open and life as normal as possible. A lot can be accomplished when everyone wears masks.

Brian: One thing that masks do is they block you from touching your mouth or touching your nose, directly anyway, after you've touched other things. David in [unintelligible 00:24:05], you're on WNYC. Hi, David.

David: Hello. Good morning, gentlemen. Brian, hope you and your family are healthy. Doctor, just a question for you. First, I'm just going to voice a little bit of I guess event, nothing too abrasive. It's just absolutely, can't say shocking anymore, but just so disturbing in the sense of this virus going just out of control at this point. What does it take for the American public, regardless of the side of the political spectrum that you're on, to get it? 250,000 people souls have passed, a million in the world. It's not made up. It's just beyond me on a regular basis.

My question for you, doctor, is if we had had a hard lockdown in the beginning, April or so, when we really knew this was getting bad, March, we knew it was getting bad, that's when we all shut down, but April when it was really exponentially growing, if we had had a hard shutdown in the sense of 99% of everything closed, except for CVS, Walgreens, pharmacies, and markets, which maybe that's what it was, but to the extent where you can't leave your house and there will be consequences if you leave your house.

We had done this for say a month and a half or so, would we be in a much better position today in the sense that even if you had it back then, you're inside for three, four weeks or so, and hopefully you're still not going to have it? Where do you think we would be today if we had done that back then? Thank you. I'm going to go off here.

Brian: Thank you very much. I'm going to add one level of challenge to the question and the premise behind the question, that again, we hear all the time coming from skeptics of closures, which says Europe experience indicates that that wouldn't have ended it because European government shutdown so much more thoroughly than the United States, but it came roaring back again. On the other hand, if we look at countries like Australia and Taiwan, we could come to a different conclusion.

Dr. James: To that latter part, I think you have to look at individual countries and why it's come back in some places. For us, if we had had a harder shutdown in the spring, that would have been undone by everything that Trump said and did. Each of these approaches, shutdowns, masking testing contact, tracing, vaccination, they're all tools in a toolbox that we have.

In an ideal world we would have had this hard shutdown once we realized that there was community spread of this virus around the country, really ramped up testing, had a completely unified message at federal and state levels, gotten everyone to slowly reopen with mask mandates, and had meticulous systems of testing and tracing so that we could have gotten the level down to very close to zero in most places, and then slowly reopened, and had been really meticulous about shutting down before there were enormous surges, we would've seen a lot less death, we would have endured less economic hardship.

It's too bad that we didn't have the leadership to accomplish that sort of thing. When you reopen, it will come back. There's no question about that. The challenge is just to try to have this steady-state, which in New York has managed pretty well. The city through the summer of having things largely open, people are out and have, it's not normal life, but it's not lockdown and we get by and you can maintain that if people are vigilant and leadership is good.

Brian: How much, in your opinion, should we be guided by the positivity rate then? For example, if it's around 3% in New York State, that's cause for concern, but it's not the 13% that Oregon has that led to that level of lockdown we described earlier.

Dr. James: That's where I think it really varies. A statewide average can be really misleading, even a citywide average at someplace like New York can be difficult. Where we need to be looking at, is this part of Brooklyn at less than 1% and there's a part of Queens that is at 15%. I'm making this up hypothetically, but it doesn't mean all of New York needs to do the same thing. It means, ideally, the more and more data that we have, the more targeted and accurate we can be about who needs to shelter, what places need to shut down, where's this transmission coming from and how do we cut it off at its source before we have to do large-scale shutdowns.

Brian: Which implies another policy dilemma. That is how local or how statewide or regional or even national, the different closures should be. We know there's a debate over national mask mandate or not but again to use Oregon as an example since I've been digging into that over the last day because of how far they're going now, they have different degrees of outbreak in different parts of the state but the restrictions to be protective are statewide.

Governor Cuomo in New York has leaned toward a local closure system by his color-coded zones that in fact are so hyper-local, kind of what you were getting at a minute ago, that he says zip codes are too blunt and measure and he wanted smaller areas than that to base policy on. Again that's so different between the statewide rules in Oregon which is, geographically, a very big state and has very different kinds of regions, urban and rural and everything, statewide versus hyper-local in New York. How do we know it's right?

Dr. James: You were dealing with a completely different question. There are twice as many people in New York City as there are in the state of Oregon. You are necessarily looking at much smaller geographic areas to cover the same number of people. You should reiterate the push to need to keep things open in New York and have these hyper-targeted lockdowns is at least in part because we don't have a stimulus package. People are not getting checks. They need to work in order to not lose their homes. That would be the ideal option, is to play it safe, draw wider radiuses, and have people stay at home if they're anywhere near one of these hot zones.

Since we don't have that, we're having to really wait and play it a little less safe and wait and only target closures in very precise areas where the numbers are known to be high. It's not the most ideal world but given the circumstances we're in, I think that is the only politically viable approach now.

Brian: One more call. Harold, a bartender in Brooklyn. You're on WNYC. Hi, Harold? Harold, listen to your phone so you get us in real-time.

Harold: Hello?

Brian: Hello, I'll have a club soda on the rocks, okay?

Harold: Oh, my God. Is this Brian Lehrer? Am I on the show?

Brian: Harold, you're on the show. Listen to your phone, not the radio.

Harold: Sorry. My radio was on in the background. My question I'll try to jump into it, is I'm a bartender, I used to be full-time now I'm part-time. I'm now even more part-time because of this 10:00 PM stuff. I just was really wondering why is it that the service industry which seems to be following so many rules, is being punished the most? I see all the people I know that work in it and myself included, we're all wearing masks, we're all cleaning everything nonstop. It just seems like the focus is on us when it should be on maybe super spreader events and parties. They do break all the rules. Sorry, I'm thinking.

Brian: That's okay. You're doing great and your point is really clear. I know that so many people in the hospitality industries feel this way. We're taking every precaution, we're following the rules, we're socially distancing in our establishments, we're wearing masks. Even if we do that, we can't stay open for indoor service. There, Dr. Hamblin is another-- it's either a dilemma or it's something that can be answered with a fact. I don't know if you're into the weeds of the data enough to know even taking those precautions, there's community spread that's being seated by indoor dining and people being in bars, or if the problem is simply that in those environments, not enough establishment are following the rules.

Dr. James: I don't know how the data breaks down on that decision. I think it's, hopefully, we can trust that rules like that would not go into effect simply for some sort of punitive reason that wasn't driven by evidence. There are going to be some situations where everyone is doing their best and it is just untenable, say, to have people inside a building. As I understand a lot of the transmissions between employees who might be gathering in the kitchen areas or staff who were in close contact throughout the course of many days versus as opposed to patrons and ideally accommodations could be made to keep places open.

I think there's an argument to be made that if we could space people out more in time to keep places open longer and have them less filled, that could be safer. That was an interesting decision and I really again wish that every time there was a regulation that asked any business to close, that it came along with a stimulus check to say, "We have to ask that you do not do business. We'll float you until you can."

Brian: To close, in your article in The Atlantic, after chewing over some of the things we've been chewing over, you closed with something that's more personal. That tells people while these policy debates are going on and we're trying to get it right. There are things you can do to protect your own self and also to be kind to others. You want to end with some version of that?

Dr. James: As much as this pandemic is a collective phenomenon, it comes down to a lot of us at home in our apartments for large portions of the day, or homes and with our very limited social circles. There's not a lot that individuals feel like we can do to effect policy or to float the businesses around us that are struggling or the people around us who are out of work or have lost family members, loved ones.

It becomes about small things and making sure that the things you can do, that you're doing that. That can be as simple as checking in on neighbors, friends and family, ideally distanced, and virtually. Just reminding yourself that other people need you and that other people are feeling the same things that you are in this difficult moment. That small gestures can go a long way to reminding everyone that real life is out there, that other people care about you, and that there's a normal world waiting for us hopefully, not more than a few more months.

Brian: Dr. James Hamblin MD, a staff writer for The Atlantic and host of their pandemic-related podcast, Social Distance. Thank you so much.

Dr. James: Thank you for having me.

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