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Brian Lehrer: Brian Lehrer on WNYC. My guest now, Dr. Leana Wen, argues that many public health officials are getting schools wrong. They should close and stay closed for the winter. She argues that Joe Biden is getting his coronavirus advisory board largely right; it emphasizes public health experts who President Trump chose to ignore. She's really glad to see Dr. Scott Atlas leave the Trump Administration today, but she wants to see Biden name more Republicans to his panel for clout and credibility.

She argues, "You should be quarantining today if you broke your usual bubble for Thanksgiving." New York, the former epicenter, and the country as a whole are now in a dangerous phase that Dr. Anthony Fauci sees as a potential surge on top of a surge because of people's Thanksgivings. For the week ending Friday, the day after Thanksgiving, November 27, an average of 1,489 Americans every day that week died from the virus. That compares with the week ending October 27th, 813 deaths a day according to The New York Times virus tracker. It's gone from around 800 up to around 1,400 per day in the last month of people dying.

In New York State, 44 people a day were dying last week, for the same week a month ago it was just 13. ICUs nationally are filling up, likely hospital staff shortages now are becoming widespread, not just concentrating in New York City and vicinity like in the spring. In New York, Governor Cuomo warn yesterday the state might be heading for another pause as it was called with more things shutting down like in the spring. Governor Newsom in California said something similar yesterday for the Golden State.

With us now is Dr. Leana Wen, emergency physician and visiting professor of Health Policy and Management at the George Washington University School of Public Health. Also a CNN medical analyst and a contributing columnist for The Washington Post. She previously has been the Baltimore City Health Commissioner and president of Planned Parenthood. Hi Dr. Wen, always good to have you with us. Welcome back to WNYC.

Dr. Leana: Thanks very much. Great to join you, Brian.

Brian: New survey data seems to suggest that the virus is spreading largely through small group gatherings. Have you been looking at this for more detail?

Dr. Leana: At this point with so much virus that’s surging across the country, it's actually very difficult for us to know exactly where people are getting infected and I'll tell you anecdotally and speaking to patients that people just really have no idea. One thing is a common trend that people are letting down their guard, in particular, with extended family and friends which in some ways is natural.

None of us want to imagine that those who we're closest to could have the virus, but we also know with COVID-19 that nearly 60% of all the spread is like people who don't have any symptoms, and that could well be people that you know and love. I think especially around holidays when people are gathering indoors, it is a time for us to really be very, very cautious. I would say at this point with so much virus that's surging, do not gather indoors including with loved ones. Really stay within your household with your pod that you've already created. Don't expand your pod at this time.

Brian: The public health consensus despite the surge seems to be leaning back toward opening schools as New York City is about to do for younger kids. You disagree. Aren't the case and transmission rates in schools proving to be remarkably low?

Dr. Leana: Yes, and I would actually just want to clarify because I heard your opening statement in this too. I think it's really essential for us to be prioritizing schools. I don't at all disagree with this. I have two young kids of my own, my mother was a school teacher, I used to run school health in Baltimore. I really understand all the reasons that we should have schools open for in-person instruction.

I think we as a society must be prioritizing this, meaning that we need to be keeping community spread as low as possible and we need to be investing the resources in order to put in the mitigation measures in schools because we do know that schools that put in these mitigation measures where they have decreased capacity, where they have improved ventilation, that they probably are low risk.

My concern is the following; just because we have seen data that's good, by the way, that schools don't result in much community transmission, that does not mean that there isn't individual risk to the staff and teachers who are in schools that have not been able to doom these upgrades. It's so essential for us to have schools open, but we as a society have failed our children.

We have decided to open bars and restaurants and gyms and other settings that are high risk, we have not kept transmission low, we have not invested in the upgrades necessary in our schools and I just think we shouldn't put the failure of our society on schools, and the teachers and staff who work in them. I think what New York is doing right now in terms of prioritizing younger children, children with special needs who must be in school, that's really critical.

I would just urge that around the country that we take a careful look at schools and don't just say a blanket statement of schools must be open period, but rather what is it that we need in order for schools to be open? Let's flip the script, not just say schools should be open regardless but ask about what is it that we as a society have to do to ensure that teachers and staff and their families are kept safe too?

Brian: The headline on that Washington Post Column of yours is "Most schools should close and stay closed through the winter." If that's not a misleading headline that somebody else wrote because I realized that columnists don't usually right there on headlines, I guess you're saying that most places have failed so much to put in these safeguards like enough ventilation and other things in the classrooms that most should just close through the winter until they can open the windows?

Dr. Leana: Look, let's look at the numbers here. In the last week for which data were available by the American Academy of Pediatrics, there were 144,000 children who were diagnosed within a single week period with COVID-19 and this is a significant underestimate given the lack of testing that's available. If you look at the CDC's own guidelines, they divide risk of spread in schools into five categories.

At least 28 states meet the CDC’s criteria for that highest risk category for transmission in schools. I think what needs to be done and the incoming Biden team should be doing this, they should be dividing the level of transmission in the community into three. If you have let's say very low test positivity, very low transmission in the community, I hope the Biden team says, "Here are the let's say 10 things that schools need to meet in order to safely reopen." If on the other hand, there is a medium risk category or a high-risk category then the schools may need to meet the following 30 or 50 criteria in order to safely reopen.

I think that most schools have said instead, we just have to reopen regardless of whether we have these measures in place, and even when there is very high rates of community transmission, they haven't been increased their mitigation measures. I just think we need to be doing things differently, and especially facing this very difficult winter ahead with surging cases and with the promise of vaccines coming in the spring.

We can be thinking differently about education, for example, let's have summer school, let's have a year-round school, let's put teachers high up on the list of people to be vaccinated, and let's get teachers back in the classroom. There are other things that we can be doing, and not just have this blanket statement of schools must be open now regardless.

Brian: Dr. Leana Wen our guest, Washington Post columnist, CNN medical analyst, George Washington University professor, former Baltimore Health Commissioner, we can take your let's say any kind of coronavirus-related call or coronavirus policy, also for Dr. Wen. 646-435-7280, 646-435-7280, or tweet a question @BrianLehrer. One of your Washington Post columns is headlined, "Stop talking about a national lockdown.' It won't happen, and it's a distraction." What do you mean by national lockdown, and what do you mean by it's a distraction?

Dr. Leana: Well, I think this is exactly it that the term lockdown has been misconstrued and applied to many things that are not actually lockdowns. Restrictions for example, on the highest risk settings like indoor bars, restaurants, that's not a lockdown. Masks mandates are certainly not lockdowns, in fact, they're the opposite, they are what prevents lockdowns from occurring.

We have seen that many states were slow or haven't even implemented mass mandates. The idea of having a lockdown where literally everybody stays at home seems to be very difficult to do politically and the more that we talk about it, the more we add confusion when actually it's these targeted restrictions that can reign in coronavirus that we should be aiming for.

That's what I meant by this that we shouldn't be using terminology that's inaccurate and I also think we need to recognize in public health that you could have a perfect policy. As in, if we actually had everybody stay at home for weeks, we could stop this pandemic, but that's not going to happen. Politically, it's just not going to happen. I would rather have a compromised policy that most people can follow, rather than an ideal policy that few people can.

Brian Lehrer: Well, Governor Cuomo in New York is warning that the trajectory of cases and hospitalizations could be leading to another what he calls pause, another pause, which is basically shut down all non-essential businesses. Last spring, we hear language from Governor Newsom in California that's different but similar. He says he's on the verge of ordering a stay-at-home policy if things continue the way they're going in California. I think we see some places in California going back to a partial stay at home, except for essential going out more at the local level. How different are those things from the kinds of national lockdowns that you say won't happen?

Dr. Leana: These are targeted restrictions that are based on evidence. You know what? Again, I think that it is important for us to say if we did literally have a stay-at-home order, where people do not leave their homes for weeks on end, we can put an end to this pandemic because this is a virus that spreads from person to person. If you curtail all transmission, you can stop it, but that's not going to happen.

We have learned a lot since the spring that we don't need that really drastic action of having everybody stay in one place. For example, back in the spring, we were closing parks and beaches versus now we know that being outdoors reduces the risk of transmission dramatically. I also would not want us to shut down all businesses, only to have people gather indoors in their homes. I wouldn't want the restaurants and bars to suffer only for people to all be getting together for game nights and dinner parties in their homes.

I think at this point, pandemic fatigue is very real. I think also that we need to be using the language of compassion and empathy and meeting people where they are and again, finding these compromised solutions, convincing people about the right thing to do in combination with using evidence-based metrics.

Brian Lehrer: Before we can make some phone calls, I'm also interested in your column about Joe Biden and that he's doing some of the right things with his coronavirus advisory board, but he should be appointing more Republicans. What are you getting at?

Leana Wen: One of the core principles in public health is that the messenger is often even more important than the message. I think that President-elect Joe Biden has already done many of the right things when it comes to coronavirus. Establishing this advisory board of top medical and scientific experts was incredible. Also, his messages thus far to unite the American people also go a long way as well in terms of exerting moral authority. The problem, though, is that we have such a polarized and divided country.

There is this wrong perception that it's Democrats and doctors that are trying to shut down the economy, that Republicans and President Trump are trying to open everything for the American people again. In order to overcome these myths, President-elect Biden also needs to enlist economists and business leaders to make it clear that public health and the economy work hand-in-hand, that they are not opposed to one another. Also having prominent Republicans, having pastors, religious leaders, are also really important because, in many communities, they are the most credible messenger.

I feel certain but I also hope that President-elect Biden as he considers a strategy moving forward, needs to reach out to a great portion of the country, the many millions of Americans for whom he is not the most credible messenger, but he needs to enlist others who can meet those individuals where they are if we have any hope of turning around this pandemic.

Brian: Here might be an example of one of those people. Vincent in East Meadow, you're on WNYC with Dr. Leana Wen. Hi, Vincent, thanks for calling in.

Vincent: Good morning, Brian. Thanks for taking my call. Yes, I would just like to bring up the Great Barrington Declaration. Dr. Lee, I'm sure that you've heard of it before. It's a panel of over 2,000 doctors that have signed up saying that the restrictions to life and the mask-wearing is actually more detrimental to our society and the future of our society, especially with the kids wearing masks than the actual virus. Considering we do have a 99.99% survival rate, do we think these restrictions are still necessary?

Brian: Can I ask you a question, Vincent? How many deaths is an acceptable number to you? If it was 800 a month in the US the week of October 27 as I was citing earlier, 800 deaths a day, now it's 1,400 deaths a day, and based on that very small percentage of people who die from the virus, cases are still going up so that very small percentage is going to mean more and more deaths per day on the current trajectory. Is that something you can shrug off?

Vincent: Brian, no deaths are acceptable, okay? I don't want anyone to pass, but the truth of the matter is, is that all the other ailments, life pending ailments, that comorbidities if you will; the heart disease, the diabetics, the cancer, they're all being clumped into this corona, unfortunately. Yes, the corona may be what took them down, but they have comorbidities that is really what has weakened the body that takes it down. If not all of us are at risk, why do we all need to use a handicap, Brian? That's actually my analogy.

Brian Lehrer: Vincent, I'm going to leave it there and get your response. Dr. Wen?

Dr. Leana: There are many inaccuracies in what Vincent said, starting with the fact that about these deaths that are reported. Actually, the deaths that are reported are an underestimate because we know that there is another statistic, the excess mortality, the individuals who would otherwise not have died if not for coronavirus. If our hospitals are overrun, what also happens is not only patients with coronavirus who are affected, is also patients with heart attacks and strokes, and cancer who are unable to get care. The best way to provide care for them is to get the virus under control.

In addition, it's not as if people with comorbidities are just destined to die. That's the same as saying, you died from a car accident but you also had cancer, therefore you didn't really die from the car accident, you had cancer, to begin with. There are more than 100 million Americans with underlying medical conditions, they were not just destined to die, coronavirus is what actually killed them. The mortality rate for coronavirus is also 3% to 4%, not 0.00% or whatever percent that Vincent cited.

In addition, this Great Barrington Declaration, this idea of having herd immunity through natural infection, which is having the infection just rip through our communities is a widely discredited theory that was promoted by Scott Atlas, Trump's advisor among other people. If we let the virus rip through our communities, we could have millions of people dying every year without the promise of long-term immunity.

I think especially with at least two vaccines that are on the horizon that people could be taking and we could get to herd immunity without millions of deaths. I think that is the path that we should be pursuing that is humane, that sensible, and that will actually save many, many millions of Americans lives.

Brian: If they have good data on how many deaths are taking place from things that are secondary to the lockdowns, this is what that group also argues that there are more drug overdose deaths because there's more of an addiction problem because there's more of a mental health problem in people who are susceptible during stay-at-home periods with the level of restrictions that places have. There are more suicides; there are more other kinds of things as well. Are there good data on that so that you can get a net excess deaths from coronavirus?

Dr. Leana: Yes. I think this is a really important point that you and Vincent raised too, which is that there are real effects of coronavirus that don't just involve the virus. We know, for example, that there is an increased rate of mental health issues that individuals who already have the disease of addiction are struggling; they have epidemic upon an epidemic if you will in this case. The problem though is, the lockdowns and these stay-at-home orders initially, were not necessarily the problem.

One of the reasons why people have not been able to seek care is that hospitals are overloaded with coronavirus patients and patients then cannot get cared for other issues. In addition, we also have to consider the mental health effects of losing someone from coronavirus, or we know that the individuals who are at the highest risk of mental health problems are those who are caregivers of those who are severely ill and have other conditions as well.

Ultimately, the solution is not let the virus run rampant, the solution should be let's do a better job of containing the virus. When I hear people say things like masks are the problem, actually if masks can keep the virus under control, if masks can then allow us to get as much of our pre-pandemic lives back to normal as possible, that's what we should be doing. That's a simple intervention that actually allows us to get back to normal. That's not the problem, is the solution.

Brian: How good is mask science?

Dr. Leana: At this point, it is very good. I will say at the beginning of this pandemic, we didn't know about the importance of wearing masks. I and other public health experts were not recommending masks. We were worried about there being a run on mask, about health care workers not having masks. We also did not know at that time about asymptomatic spread, and about aerosol spread. We thought it was only people coughing and sneezing and having symptoms who needed to wear masks because they were the ones transmitting it.

Now that we know about aerosol spread, about the level of asymptomatic transmission, that's why we're recommending masks. That's why we know too based on many studies that masks protect other people from you if you are an asymptomatic carrier and don't know it. Masks also protect you, the wearer, which is why healthcare workers wear masks. I think at this point, we have very good science, and also many models project that if we wear masks this winter, that we could prevent tens of thousands of people from dying from coronavirus.

Brian: With Dr. Leana Wen, this is WNYC-FM HD NAM New York, WNJT FM 88.1 Trenton, WNJP 88.5 Sussex, WNJY 89.3 Nepcon, and WNGO 90.3 Toms River. We are in New York and New Jersey public radio. Marta, in Manhattan, you're on WNYC with Dr. Wen. Hello, Marta.

Marta: Hi, it's Marta. Thank you for taking my call. My concern relates to self-quarantining. I'm aware of two people who were supposedly self-quarantining and had other people in and out of their apartments and I don't believe wearing masks all the time. My thought is that not enough is being said on the media about how properly the self-quarantine and many people really don't know how to do it.

Brian: Well, that's an interesting point and question that you raised. Dr. Wen, another one of your recent columns was about how people who broke their bubbles in their pods for Thanksgiving should be quarantining right now, right?

Leana Wen: That's right. I just want to distinguish the terminology here as well. Isolation refers to if somebody is ill, has tested positive, has symptoms, for example, and they need to isolate during the time that they are symptomatic and from 10 days after the diagnosis. That's one thing and certainly, it's very difficult but is really necessary if you're ill and your family members are not that you have proper precautions. The CDC on their website has very good guidance on what to do if you're ill and symptomatic.

Quarantining usually refers to what happens when you are exposed to somebody who is ill or has tested positive, and you have had a significant contact with them and need to be quarantining yourself. I'm actually referring to something else which is related, which is this idea that if you've traveled over Thanksgiving, and if you were in indoor gatherings with others, again, I really wish that that didn't happen because we know that with this level of coronavirus all around, that you could be at high risk if you are then around others in indoor settings that are high risk gathered around a dinner table without wearing a mask for long periods of time. That's high risk.

If you already engaged in those activities, I believe you should consider yourself to be at high risk. Therefore, you should treat yourself as if you had exposure to somebody who has coronavirus, you should be quarantining. In that case, I specifically referred to not seeing anyone else indoors during that period of time that you're quarantining, which is at least seven days, and then get a test, or 14 days if you're not able to get a test. During that time, you should not be around other people.

Do not get together with other people for dinner, don't go in person to work, take your kids out of school, or take care for that period of time if you have been exposed to others in a high-risk way, which I believe is really any indoor gathering with others at this point unless they're in your pod. I hope that clarifies for the listener and I would just add that I would have the same advice over Christmas and Hanukkah, and in the New Years' too. We just have so much coronavirus at this point; I really would urge people not to get together indoors.

Brian: Dr. Wen, let me ask you one final question. As we transition to the Biden administration and very different messaging at very least on coronavirus, how much do you think it's going to matter? I ask you because of Europe where they haven't had a denying Donald in office as a head of state in almost any European country.

Maybe Boris Johnson started out that way, but I think he got religion on this after he got sick. What was happening in his population, and they've also had much stricter lockdowns in the earliest phase than the United States ever had, especially in France and Italy, and yet they are surging like bad too, as well. Probably proportionate to the United States. Maybe you know how close it is. How much does national policy matter?

Dr. Leana: I think it matters a lot. Actually, we are seeing the effect of national policy in Europe now that they have implemented as a result of surging cases. They did implement a set of strict restrictions that have been very hard. Yes, there have been protests, not everyone has followed them, but as a result, they have been able to control their search. They have avoided this catastrophe that I'm afraid is on the way for the United States, which is overwhelmed healthcare systems to the point that our health care system is at the brink of collapse. I think policies do matter.

I also think that for something like public health, where we're asking people to do things that are so against what they normally would want to do like the idea of staying at home and away from our loved ones, it's not at all what we're comfortable with. Wearing masks, we're not a mask-wearing culture. We really need to have the public's involvement and people need to buy into this. I think that is Joe Biden's biggest challenge at this point is how can he win hearts and minds and get people to follow the important public health guidance, knowing that where we are now as a country is so different than if he weren't in office back in February when everything started.

We have gone down this path and our country is so polarized, something as basic as mass squaring has been so politicized has become this ideological cultural touchpoint and dividing line in a way that it really shouldn't have happened, but since that is the case, we need everyone to do our part, but I also hope that the president-elect enlists as many credible messengers as he can in this effort.

Brian: Dr. Leana Wen teaching at George Washington University, writing columns for The Washington Post, on TV is a CNN medical analyst, previously the Baltimore City Health Commissioner. Thank you so much for joining us as always.

Dr. Leana: Thank you, Brian.

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